Provider Demographics
NPI:1588615710
Name:GRILLO, LYNN (NP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GRILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 N OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3667
Mailing Address - Country:US
Mailing Address - Phone:703-362-3950
Mailing Address - Fax:
Practice Address - Street 1:2038 N OAKLAND ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3667
Practice Address - Country:US
Practice Address - Phone:703-362-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8935823Medicaid
VA1588615710OtherNPI
VA500000995Medicare ID - Type Unspecified
VAP46128Medicare UPIN