Provider Demographics
NPI:1982019881
Name:LYNN, BRANDY JO (MAOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:JO
Last Name:LYNN
Suffix:
Gender:F
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 DACIAN AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1702
Mailing Address - Country:US
Mailing Address - Phone:512-496-3319
Mailing Address - Fax:
Practice Address - Street 1:904 DACIAN AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1702
Practice Address - Country:US
Practice Address - Phone:512-496-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist