Provider Demographics
NPI:1306173232
Name:WILEY, LYN MARIE (COMS)
Entity type:Individual
Prefix:MS
First Name:LYN
Middle Name:MARIE
Last Name:WILEY
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:BLDG 77
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-3782
Mailing Address - Fax:612-629-7702
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:BLDG 77
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3782
Practice Address - Fax:612-629-7702
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind