Provider Demographics
NPI:1487224234
Name:LYNN, STEPHANIE SHANE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SHANE
Last Name:LYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10861 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92223-4691
Mailing Address - Country:US
Mailing Address - Phone:951-902-5187
Mailing Address - Fax:
Practice Address - Street 1:10861 NOBLE ST
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92223-4691
Practice Address - Country:US
Practice Address - Phone:951-902-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider