Provider Demographics
NPI:1952300352
Name:VALENTINE, LYNN ELLEN (DNSC)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ELLEN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:DNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4856
Mailing Address - Country:US
Mailing Address - Phone:434-817-8484
Mailing Address - Fax:434-817-8490
Practice Address - Street 1:1139 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4856
Practice Address - Country:US
Practice Address - Phone:434-817-8484
Practice Address - Fax:434-817-8490
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024088872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA500001098Medicare ID - Type UnspecifiedMEDICARE NUMBER