Provider Demographics
NPI:1083971147
Name:MARSHALL, LYNETTE VICTORIA (ARNP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:VICTORIA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3550
Mailing Address - Country:US
Mailing Address - Phone:509-494-6700
Mailing Address - Fax:509-573-6275
Practice Address - Street 1:51781 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-1118
Practice Address - Country:US
Practice Address - Phone:541-907-7040
Practice Address - Fax:541-907-7059
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60296830363LF0000X
WARN001106896163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021778Medicaid
WARN00106896OtherRN LICENSE
WAAP60296830OtherARNP LICENSE
WA0417847OtherLABOR AND INDUSTRIES