Provider Demographics
NPI:1548389398
Name:WACHTLER, LYNN MARIE (CNP)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:WACHTLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033
Mailing Address - Country:US
Mailing Address - Phone:651-539-2418
Mailing Address - Fax:651-480-0052
Practice Address - Street 1:1200 18TH ST E
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3680
Practice Address - Country:US
Practice Address - Phone:651-539-2418
Practice Address - Fax:651-438-8536
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR116570-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily