Provider Demographics
NPI:1962056432
Name:BRATBERG, LYNDSEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:MARIE
Last Name:BRATBERG
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-4660
Mailing Address - Fax:414-805-2934
Practice Address - Street 1:F&MCW CLINICAL CANCER CENTER 9200 W. WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-805-0505
Practice Address - Fax:414-805-2934
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962056432Medicaid