Provider Demographics
NPI:1588876148
Name:MISKOVICH, LYNN MARIE (APN)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:MISKOVICH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8722 FOREST GLEN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8795
Mailing Address - Country:US
Mailing Address - Phone:219-741-2568
Mailing Address - Fax:
Practice Address - Street 1:5514 S HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1933
Practice Address - Country:US
Practice Address - Phone:219-933-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001061A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health