Provider Demographics
NPI:1275516015
Name:LYNN, ROBERT J (APN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:LYNN
Suffix:
Gender:M
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 530010
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0010
Mailing Address - Country:US
Mailing Address - Phone:702-361-2273
Mailing Address - Fax:702-361-6885
Practice Address - Street 1:9975 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-7950
Practice Address - Country:US
Practice Address - Phone:702-361-2273
Practice Address - Fax:702-361-6885
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101737Medicare ID - Type UnspecifiedGROUP
NVP41639Medicare UPIN
NV101986Medicare ID - Type UnspecifiedINDIVIDUAL