Provider Demographics
NPI:1740403096
Name:WETMORE, LYNN ELIZABETH (LAC)
Entity type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:ELIZABETH
Last Name:WETMORE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUNLIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-1898
Mailing Address - Country:US
Mailing Address - Phone:406-595-0225
Mailing Address - Fax:
Practice Address - Street 1:8707 JACKRABBIT LN STE C
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8995
Practice Address - Country:US
Practice Address - Phone:406-595-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT203171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist