Provider Demographics
NPI:1811542616
Name:DULLE, LYNN ELIZABETH
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELIZABETH
Last Name:DULLE
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 1:3360 N HIGHWAY 59 STE K
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9405
Mailing Address - Country:US
Mailing Address - Phone:209-483-3509
Mailing Address - Fax:
Practice Address - Street 1:19960 AMERICAN AVE SPC 60
Practice Address - Street 2:
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-9352
Practice Address - Country:US
Practice Address - Phone:209-483-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator