Provider Demographics
NPI:1326291626
Name:GOTLER, LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:GOTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MARINER GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-2055
Mailing Address - Country:US
Mailing Address - Phone:415-342-3414
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE PALLIATIVE CARE
Practice Address - Street 2:99 MONTICILLO RD TRAILER 7
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-444-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491375163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse