Provider Demographics
NPI:1164949954
Name:LARUE, LYNDA ODEN (CRNP)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:ODEN
Last Name:LARUE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:FAY
Other - Last Name:ODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 BULLARD RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35031-3651
Mailing Address - Country:US
Mailing Address - Phone:205-288-1913
Mailing Address - Fax:
Practice Address - Street 1:150 GILBREATH DR STE 201
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2827
Practice Address - Country:US
Practice Address - Phone:205-274-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1050053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty