Provider Demographics
NPI:1578565446
Name:MARQUARDT, LYNN M (DNP, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:DNP, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 S NEENAH AVENUE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3532
Mailing Address - Country:US
Mailing Address - Phone:920-746-5091
Mailing Address - Fax:
Practice Address - Street 1:1118 S NEENAH AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1936
Practice Address - Country:US
Practice Address - Phone:920-746-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI672-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43929800Medicaid
WIS98827Medicare UPIN