Provider Demographics
NPI:1609953561
Name:STRUEH, LYNN L (NP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:L
Last Name:STRUEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2792
Mailing Address - Country:US
Mailing Address - Phone:765-482-7005
Mailing Address - Fax:765-483-3021
Practice Address - Street 1:1310 S LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2792
Practice Address - Country:US
Practice Address - Phone:765-482-7005
Practice Address - Fax:765-483-3021
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200513460Medicaid
IN151560O6Medicare PIN
IN152410MMMedicare PIN
INQ33892Medicare UPIN