Provider Demographics
NPI:1194357830
Name:SMITH, LYNNETTE LEA (AGNP)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:LEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CIMARRON DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9791
Mailing Address - Country:US
Mailing Address - Phone:319-241-5935
Mailing Address - Fax:
Practice Address - Street 1:2460 TOWNCREST DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6622
Practice Address - Country:US
Practice Address - Phone:319-338-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH157739363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care