Provider Demographics
NPI:1154617116
Name:JANZEN, LYNSEY LEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LYNSEY
Middle Name:LEE
Last Name:JANZEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LYNSEY
Other - Middle Name:LEE
Other - Last Name:HEPNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 W TECUMSEH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1810
Mailing Address - Country:US
Mailing Address - Phone:405-515-2222
Mailing Address - Fax:405-515-2249
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-515-2222
Practice Address - Fax:405-515-2249
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant