Provider Demographics
NPI:1821647983
Name:VU, LYNN THI (BSN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:THI
Last Name:VU
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MENTONE BLVD SPC 23
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-9645
Mailing Address - Country:US
Mailing Address - Phone:909-362-9684
Mailing Address - Fax:
Practice Address - Street 1:2140 MENTONE BLVD SPC 23
Practice Address - Street 2:
Practice Address - City:MENTONE
Practice Address - State:CA
Practice Address - Zip Code:92359-9645
Practice Address - Country:US
Practice Address - Phone:909-362-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95059690163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine