Provider Demographics
NPI:1598131278
Name:MOON, LYNETTE (PA-C)
Entity Type:Individual
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First Name:LYNETTE
Middle Name:
Last Name:MOON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 HOSPITAL LN
Mailing Address - Street 2:STE 100
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1993
Mailing Address - Country:US
Mailing Address - Phone:317-865-2955
Mailing Address - Fax:317-865-2954
Practice Address - Street 1:8051 S EMERSON AVE
Practice Address - Street 2:#200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8600
Practice Address - Country:US
Practice Address - Phone:317-865-2955
Practice Address - Fax:317-865-2954
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-07-29
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Provider Licenses
StateLicense IDTaxonomies
IN10001891A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant