Provider Demographics
NPI:1770328528
Name:BROUILLETTE, LYNSEY (DNP ARNP)
Entity type:Individual
Prefix:
First Name:LYNSEY
Middle Name:
Last Name:BROUILLETTE
Suffix:
Gender:F
Credentials:DNP ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-1325
Mailing Address - Country:US
Mailing Address - Phone:712-880-2666
Mailing Address - Fax:
Practice Address - Street 1:513 S MUCKEY ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:IA
Practice Address - Zip Code:51034-1055
Practice Address - Country:US
Practice Address - Phone:712-882-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA179930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine