Provider Demographics
NPI:1275630048
Name:OVESON, LYNN ELIZABETH (ANP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELIZABETH
Last Name:OVESON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA CTR
Mailing Address - Street 2:350 PARNASSUS AVENUE BOX 0327
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-353-9088
Mailing Address - Fax:415-353-3889
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA CTR
Practice Address - Street 2:350 PARNASSUS AVENUE BOX 0327
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-9088
Practice Address - Fax:415-353-3889
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000030160RN363LA2200X
OR000030160N3363LA2200X
CANP18742363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR012463Medicaid
OR012463Medicaid