Provider Demographics
NPI:1568621951
Name:BERDOFE, LYNNE R (APRN, WHNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:R
Last Name:BERDOFE
Suffix:
Gender:F
Credentials:APRN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 AMANDAS WAY
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2925
Mailing Address - Country:US
Mailing Address - Phone:512-796-1521
Mailing Address - Fax:
Practice Address - Street 1:1180 SETON PKWY
Practice Address - Street 2:SUITE 340
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:512-504-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111327363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX584172OtherSTATE LICENSE NUMBER