Provider Demographics
NPI:1619522323
Name:AVERA, LYNDA MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:MICHELLE
Last Name:AVERA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3243
Mailing Address - Country:US
Mailing Address - Phone:843-375-2210
Mailing Address - Fax:843-375-2214
Practice Address - Street 1:1300 HOSPITAL DR STE 150
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3243
Practice Address - Country:US
Practice Address - Phone:843-375-2210
Practice Address - Fax:843-375-2214
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22458363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty