Provider Demographics
NPI:1194775973
Name:WILLETT, LYNNE D (MD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:D
Last Name:WILLETT
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 1:8200 DODGE ST.
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-955-6140
Mailing Address - Fax:402-955-3398
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-955-6140
Practice Address - Fax:402-955-3398
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010144812080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136780001Medicaid
MO202554812Medicaid
KY64068919Medicaid
370020196OtherRAILROAD MEDICARE
466289OtherHEALTHLINK
MO148069OtherBCBS
MO202554812Medicaid
MO148069OtherBCBS