Provider Demographics
NPI:1497708267
Name:ANESKIEVICH, LYNN MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:ANESKIEVICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE. 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6307
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:2ND FLOOR ANESTHESIA DEPT.
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7111
Practice Address - Fax:864-455-6441
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN508367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0462Medicaid
SC576007863OtherAETNA
SC576007863OtherCIGNA
SC20031911OtherSELECT HEALTH GROUP
SC576007863OtherUHC
SC20031364OtherINDIVIDUAL SELECT HEALTH
SC430034359OtherMEDICARE RAILROAD ID
SC576007863OtherBLUE CHOICE
SC576007863OtherBCBS
SC576007863OtherAETNA