Provider Demographics
NPI:1609485929
Name:LYNXSURE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:LYNXSURE WELLNESS CENTER LLC
Other - Org Name:LYNXSURE WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:CONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-927-3510
Mailing Address - Street 1:7323 HANOVER PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3617
Mailing Address - Country:US
Mailing Address - Phone:301-477-3676
Mailing Address - Fax:240-297-9855
Practice Address - Street 1:7323 HANOVER PKWY STE A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3617
Practice Address - Country:US
Practice Address - Phone:301-477-3676
Practice Address - Fax:240-297-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty