Provider Demographics
NPI:1477957017
Name:ORSBURN, LYNDA
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:ORSBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6946 46TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1749
Mailing Address - Country:US
Mailing Address - Phone:262-764-0377
Mailing Address - Fax:262-654-5661
Practice Address - Street 1:6946 46TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1749
Practice Address - Country:US
Practice Address - Phone:262-764-0377
Practice Address - Fax:262-654-5661
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver