Provider Demographics
NPI:1376952416
Name:VANNOSTRAND, LYNETTE (BA, AS, RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:VANNOSTRAND
Suffix:
Gender:F
Credentials:BA, AS, RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 PINEHURST WAY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-8524
Mailing Address - Country:US
Mailing Address - Phone:717-512-3441
Mailing Address - Fax:
Practice Address - Street 1:5615 PINEHURST WAY
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-8524
Practice Address - Country:US
Practice Address - Phone:717-512-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000037124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist