NPIMap

Organization Active NPI

LKW Health LLC

Doing business as Lynn K Wagner, MD Integrative Medicine

  • Medical Specialty Clinic/Center
  • De Pere, WI
National Provider Identifier
1710512819
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
LKW HEALTH LLC
Doing business as
Lynn K Wagner, MD Integrative Medicine
Practice address
106 N Wisconsin St
De Pere, WI 54115-2733
Phone
(920) 327-7056
Fax
(920) 425-4955
NPI assigned
Mar 9, 2020
Last updated
Mar 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kasi Stankevich
Title
Clinic Manager
Phone
(920) 632-7158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X NU Primary

Addresses

Primary practice location

106 N Wisconsin St
De Pere, WI 54115-2733

Mailing address

106 N Wisconsin St
De Pere, WI 54115-2733
Phone (920) 327-7056

Other names 1

  • Lynn K Wagner, MD Integrative Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

106 N Wisconsin St
De Pere, WI 54115
Phone (920) 327-7056

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1710512819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 N WISCONSIN ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152733",
            "telephone_number": "920-327-7056",
            "fax_number": "920-425-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N WISCONSIN ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152733",
            "telephone_number": "920-327-7056",
            "fax_number": "920-425-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LKW HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "STANKEVICH",
        "authorized_official_first_name": "KASI",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "920-632-7158"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lynn K Wagner, MD Integrative Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.