Provider Demographics
NPI:1508131749
Name:CROCKER, LYNNETTE GUY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:GUY
Last Name:CROCKER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NW 24TH CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-4318
Mailing Address - Country:US
Mailing Address - Phone:561-278-9461
Mailing Address - Fax:561-278-9461
Practice Address - Street 1:22 NW 24TH CT
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-4318
Practice Address - Country:US
Practice Address - Phone:561-278-9461
Practice Address - Fax:561-278-9461
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1077972163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant