Provider Demographics
NPI:1013348903
Name:GREEN, LYN (CRNA)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LYN
Other - Middle Name:
Other - Last Name:CABIGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:207 FIESTA WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9562
Mailing Address - Country:US
Mailing Address - Phone:702-481-0938
Mailing Address - Fax:
Practice Address - Street 1:2700 LOW CT FL 2
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9778
Practice Address - Country:US
Practice Address - Phone:707-432-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN52158163W00000X
CA95051347163W00000X
CA95000272367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse