Provider Demographics
NPI:1558075929
Name:LYNN, DEANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 CLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1757
Mailing Address - Country:US
Mailing Address - Phone:209-277-7513
Mailing Address - Fax:
Practice Address - Street 1:156 CLIPPER LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1757
Practice Address - Country:US
Practice Address - Phone:209-277-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program