Provider Demographics
NPI:1437329984
Name:WILSON, LYNNE MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:MARIE
Last Name:WILSON
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:PO BOX 7549
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-7549
Mailing Address - Country:US
Mailing Address - Phone:951-358-7720
Mailing Address - Fax:951-358-7710
Practice Address - Street 1:3840 MYERS ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3614
Practice Address - Country:US
Practice Address - Phone:951-358-7720
Practice Address - Fax:951-358-7710
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585517163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health