Provider Demographics
NPI:1003357344
Name:LYNAM, HAYLEY MEGAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HAYLEY
Middle Name:MEGAN
Last Name:LYNAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:MEGAN
Other - Last Name:RUTLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2250 S MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2538
Mailing Address - Country:US
Mailing Address - Phone:951-737-1454
Mailing Address - Fax:
Practice Address - Street 1:2250 S MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2501
Practice Address - Country:US
Practice Address - Phone:951-371-2703
Practice Address - Fax:951-371-9348
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA54290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant