Provider Demographics
NPI:1518068485
Name:HARTZ, LYNN ELLEN (ANP FNP MSN)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ELLEN
Last Name:HARTZ
Suffix:
Gender:F
Credentials:ANP FNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3104 BROOKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1882
Mailing Address - Country:US
Mailing Address - Phone:907-248-4877
Mailing Address - Fax:907-561-1257
Practice Address - Street 1:4231 LAKE OTIS PARKWAY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5214
Practice Address - Country:US
Practice Address - Phone:907-562-2965
Practice Address - Fax:907-561-1257
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6966363LF0000X, 363LW0102X
AK0006363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2937034OtherCIGNA
AKNP5782Medicaid
AK11532981OtherCAQH
AK7382061OtherAETNA
AKNP5782Medicaid