Provider Demographics
NPI:1235463480
Name:KADY, LYNETTE FAWNE
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:FAWNE
Last Name:KADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ADAMS ST NE
Mailing Address - Street 2:APT. E 09
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5047
Mailing Address - Country:US
Mailing Address - Phone:505-486-4398
Mailing Address - Fax:
Practice Address - Street 1:1414 ADAMS ST NE
Practice Address - Street 2:APT. E 09
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5047
Practice Address - Country:US
Practice Address - Phone:505-486-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide