Provider Demographics
NPI:1063834968
Name:VIXAMAR, LYNDA
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:VIXAMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:VIXAMAR PIERRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3501 FOSTER AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-6416
Mailing Address - Country:US
Mailing Address - Phone:347-579-4577
Mailing Address - Fax:
Practice Address - Street 1:3501 FOSTER AVE APT 6B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-6416
Practice Address - Country:US
Practice Address - Phone:347-579-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-11
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY712257163W00000X
NY316129164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse