Provider Demographics
NPI:1306083589
Name:GRINOLD, LYNNE ALFORD (RN-C,IBCLC,RLC,CDE)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:ALFORD
Last Name:GRINOLD
Suffix:
Gender:F
Credentials:RN-C,IBCLC,RLC,CDE
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 15251
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3105
Mailing Address - Country:US
Mailing Address - Phone:904-310-6316
Mailing Address - Fax:
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-321-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9280914163WL0100X
FL09910249163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant