Provider Demographics
NPI:1942412473
Name:WIENS, LYNETTE JOY (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:JOY
Last Name:WIENS
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 1:21271 PINEBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3344
Mailing Address - Country:US
Mailing Address - Phone:949-525-2540
Mailing Address - Fax:
Practice Address - Street 1:28201 MARGUERITE PKWY
Practice Address - Street 2:SUITE 13
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3719
Practice Address - Country:US
Practice Address - Phone:949-364-3928
Practice Address - Fax:949-364-2298
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449145163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory