Provider Demographics
NPI:1790820090
Name:LYNN, REBECCA (MA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:YEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:84-721 UPENA ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-1937
Mailing Address - Country:US
Mailing Address - Phone:808-275-6247
Mailing Address - Fax:808-523-1997
Practice Address - Street 1:1100 ALAKEA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2833
Practice Address - Country:US
Practice Address - Phone:808-523-7771
Practice Address - Fax:808-523-1997
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000596114OtherMAKAHA