Active NPI
Lynne M. Edebohls, APNP
- Pediatric Nurse Practitioner
- Lake Mills, WI
National Provider Identifier
1154438760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 1323-33
- Practice address
- 1025 Mulberry St
Lake Mills, WI 53551-1304 - Phone
- (920) 648-4518
- Fax
- (920) 648-1623
- NPI assigned
- Aug 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 1323-33 | WI | Primary |
Addresses
Primary practice location
1025 Mulberry St
Lake Mills, WI 53551-1304
Mailing address
1025 Mulberry St
Lake Mills, WI 53551-1304
Phone (920) 648-4518
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43891700 | Medicaid | WI | |
| 000854100 | Other | MEDICARE A |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490659200000",
"number": "1154438760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 MULBERRY ST",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535511304",
"telephone_number": "920-648-4518",
"fax_number": "920-648-1623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 MULBERRY ST",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535511304",
"telephone_number": "920-648-4518",
"fax_number": "920-648-1623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDEBOHLS",
"first_name": "LYNNE",
"middle_name": "M.",
"name_prefix": "Mrs.",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-23",
"last_updated": "2017-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "WI",
"license": "1323-33",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43891700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE A",
"identifier": "000854100",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Mills, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.