1932201720 NPI number — REBECCA R LYMAN M.D.

Table of content: REBECCA R LYMAN M.D. (NPI 1932201720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932201720 NPI number — REBECCA R LYMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYMAN
Provider First Name:
REBECCA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932201720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CROIX FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54024-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-483-3221
Provider Business Mailing Address Fax Number:
715-483-0507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CROIX FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54024-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-483-3221
Provider Business Practice Location Address Fax Number:
715-483-0507
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  37760 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0110870 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32233100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080099998 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64Q32LY . This is a "BLUE CROSS MN PRO FEE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NA9031011612 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP19421 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27G41LY . This is a "BLUE CROSS MN FACILITY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 475518900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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