Provider Demographics
NPI:1710511837
Name:WIN, LYNNELLE
Entity Type:Individual
Prefix:
First Name:LYNNELLE
Middle Name:
Last Name:WIN
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 1:2740 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-924-0460
Mailing Address - Fax:559-299-1421
Practice Address - Street 1:16835 ALKALI DR STE M
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9463
Practice Address - Country:US
Practice Address - Phone:559-924-1541
Practice Address - Fax:559-299-1421
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13678124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist