Provider Demographics
NPI:1932287885
Name:SHOEMAKER, LYNN ALLEN
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ALLEN
Last Name:SHOEMAKER
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 1:1900 STATE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2429
Mailing Address - Country:US
Mailing Address - Phone:805-617-7850
Mailing Address - Fax:805-898-2002
Practice Address - Street 1:1900 STATE ST
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2429
Practice Address - Country:US
Practice Address - Phone:805-617-7850
Practice Address - Fax:805-898-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12368363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12368OtherPHYSICIAN ASSISTANT
CAMS1449873OtherDEA
CAPA12368OtherPHYSICIAN ASSISTANT
CAQ75127Medicare UPIN