Provider Demographics
NPI:1962471979
Name:MOON, LYNNE H (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:H
Last Name:MOON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 SW RANCH TRL
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7955
Mailing Address - Country:US
Mailing Address - Phone:772-260-0469
Mailing Address - Fax:772-781-0563
Practice Address - Street 1:3441 SE WILLOUGHBY BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5060
Practice Address - Country:US
Practice Address - Phone:772-221-4030
Practice Address - Fax:772-221-4966
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1026312163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health