Provider Demographics
NPI:1679874424
Name:NALODKA, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:NALODKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 MIRAMAR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-2417
Mailing Address - Country:US
Mailing Address - Phone:512-663-1999
Mailing Address - Fax:
Practice Address - Street 1:11125 MIRAMAR DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-2417
Practice Address - Country:US
Practice Address - Phone:512-663-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137586251E00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility