Provider Demographics
NPI:1114413846
Name:BROWN, LYNETTE FAY (BSN, RN)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:FAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:FAY
Other - Last Name:HAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 E SOUTH TEMPLE STE 1400
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1143
Mailing Address - Country:US
Mailing Address - Phone:385-258-2751
Mailing Address - Fax:
Practice Address - Street 1:136 E SOUTH TEMPLE STE 1400
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1143
Practice Address - Country:US
Practice Address - Phone:385-258-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00168855163W00000X
NM71689363LF0000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily