Provider Demographics
NPI:1487141214
Name:WELZENBACH, LYNN ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:WELZENBACH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:210 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:888-256-3814
Mailing Address - Fax:888-256-9054
Practice Address - Street 1:1089 JORDAN CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5830
Practice Address - Country:US
Practice Address - Phone:515-531-8013
Practice Address - Fax:833-983-2836
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAH071512363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner