Provider Demographics
NPI:1114976487
Name:ANDERSON, LYNN (APN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2350
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89505-2350
Mailing Address - Country:US
Mailing Address - Phone:775-784-1223
Mailing Address - Fax:775-327-2009
Practice Address - Street 1:1664 N VIRGINIA ST # MS 152
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557
Practice Address - Country:US
Practice Address - Phone:775-784-4414
Practice Address - Fax:775-784-4468
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN12861163W00000X
NVAPN000686367A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1114976487Medicaid