Provider Demographics
NPI:1386733749
Name:CATLIN-ENSOR, LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:CATLIN-ENSOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39002 RYANS BAY RD
Mailing Address - Street 2:
Mailing Address - City:ZUMBRO FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55991-5276
Mailing Address - Country:US
Mailing Address - Phone:507-753-3244
Mailing Address - Fax:
Practice Address - Street 1:39002 RYANS BAY RD
Practice Address - Street 2:
Practice Address - City:ZUMBRO FALLS
Practice Address - State:MN
Practice Address - Zip Code:55991-5276
Practice Address - Country:US
Practice Address - Phone:507-753-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0449363A00000X
MN10319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN634672000Medicaid
MN970003070Medicare PIN