Provider Demographics
NPI:1841244969
Name:ANDERSON, LYNNETTE J (APNP)
Entity Type:Individual
Prefix:MS
First Name:LYNNETTE
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC BONE MARROW TRANSPLANT
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2593
Mailing Address - Fax:414-266-3682
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC BONE MARROW TRANSPLANT
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2593
Practice Address - Fax:414-266-3682
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1146363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
002806261JOtherHUMANA
WI43991300Medicaid
WI1841244969Medicaid
WI43991300Medicaid
0016G73601Medicare ID - Type Unspecified