Provider Demographics
NPI:1790824498
Name:MILLIMAN, LYNN L (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:L
Last Name:MILLIMAN
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0293
Mailing Address - Country:US
Mailing Address - Phone:318-283-3930
Mailing Address - Fax:318-239-8930
Practice Address - Street 1:430 S VINE ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4514
Practice Address - Country:US
Practice Address - Phone:318-283-3930
Practice Address - Fax:318-239-8930
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03436363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1180858Medicaid
LAP26728Medicare UPIN
LA1180858Medicaid