Provider Demographics
NPI:1538278403
Name:QUIST-CALLAHAN, LYNETTE M (CRNA)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
Last Name:QUIST-CALLAHAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:M
Other - Last Name:QUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:211 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5049
Mailing Address - Country:US
Mailing Address - Phone:573-331-5114
Mailing Address - Fax:913-341-5797
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5114
Practice Address - Fax:913-341-5797
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO125093367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO405586OtherBCBS
MOP00353187OtherRAILROAD MEDICARE
MO917221707Medicaid
MO917221707Medicaid
MO826110024Medicare PIN
IL$$$$$$$$$001Medicaid