Provider Demographics
NPI:1760494223
Name:GOUDLOCK, LYNNE CAROL (LPN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:CAROL
Last Name:GOUDLOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 PEELER RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-8730
Mailing Address - Country:US
Mailing Address - Phone:803-955-3320
Mailing Address - Fax:
Practice Address - Street 1:265 PEELER RD
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8730
Practice Address - Country:US
Practice Address - Phone:803-955-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR32978164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse