Provider Demographics
NPI:1275590960
Name:ATWOOD, LYNNE G (CNM, CFNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:G
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:CNM, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4052 W 3390 S
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2062
Mailing Address - Country:US
Mailing Address - Phone:801-964-3758
Mailing Address - Fax:801-964-3797
Practice Address - Street 1:4052 W 3390 S
Practice Address - Street 2:SUITE # 205
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2062
Practice Address - Country:US
Practice Address - Phone:801-964-3758
Practice Address - Fax:801-964-3797
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT204915-4405363LF0000X
UT204915-4402363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR8015OtherMEDICAID SERVICING LICENS
UTR8015OtherMEDICAID SERVICING LICENS