Provider Demographics
NPI:1619451036
Name:VANDECAVEYE, LYNZEE (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNZEE
Middle Name:
Last Name:VANDECAVEYE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12782 KELLY K DR
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9713
Mailing Address - Country:US
Mailing Address - Phone:173-473-5938
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH427062163W00000X
OH019787367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse