Provider Demographics
NPI:1659422962
Name:HEDSTROM, LYNDA RAE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:RAE
Last Name:HEDSTROM
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3542 MILL RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5520
Mailing Address - Country:US
Mailing Address - Phone:770-297-8072
Mailing Address - Fax:770-582-4189
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:SUITE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:770-582-4190
Practice Address - Fax:770-582-4189
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN141151 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily