Provider Demographics
NPI:1215943352
Name:BEHNKE, LYN M (DNP)
Entity type:Individual
Prefix:DR
First Name:LYN
Middle Name:M
Last Name:BEHNKE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9301
Mailing Address - Country:US
Mailing Address - Phone:989-254-2131
Mailing Address - Fax:989-305-6342
Practice Address - Street 1:808 W LAKE ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9301
Practice Address - Country:US
Practice Address - Phone:989-254-2131
Practice Address - Fax:989-305-6342
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704123071363LF0000X, 363L00000X
WY33828.1323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704123071OtherLICENSE
MI4704123071OtherLICENSE
MIP24490006Medicare PIN
MIP24490006Medicare PIN