Provider Demographics
NPI:1891987533
Name:MOSBAUGH, LYNNE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:M
Last Name:MOSBAUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2280
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-2280
Mailing Address - Country:US
Mailing Address - Phone:970-668-9161
Mailing Address - Fax:
Practice Address - Street 1:36 PEAK ONE DRIVE, SUITE 230
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-9161
Practice Address - Fax:970-668-4115
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07430895Medicaid