Provider Demographics
NPI:1982024154
Name:STILES, LYNNETTE JO (RNC-IBCLC)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:JO
Last Name:STILES
Suffix:
Gender:F
Credentials:RNC-IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:PPS BUSINESS OFFICE
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-283-2781
Mailing Address - Fax:928-283-2677
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:928-283-2677
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165443-30163W00000X
CT03-666262163W00000X
CA608203163W00000X
FLRN9220737163W00000X
VT026.0028762163W00000X
MNR92090-2163WM0102X
VA14957 IBCLC163WM0102X
ARSTI104300163163WX0003X
196-13641174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No174N00000XOther Service ProvidersLactation Consultant, Non-RN