Provider Demographics
NPI:1245281039
Name:LAMP, LYNETTE MARIE (MD)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:MARIE
Last Name:LAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MN
Mailing Address - Zip Code:55972-2127
Mailing Address - Country:US
Mailing Address - Phone:507-932-3810
Mailing Address - Fax:
Practice Address - Street 1:403 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MN
Practice Address - Zip Code:55972-2127
Practice Address - Country:US
Practice Address - Phone:507-932-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30220207Q00000X
MN51610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0114975Medicaid
F92704Medicare UPIN