Provider Demographics
NPI:1245778331
Name:NEVATT, LYNN (ESTHETICIAN)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:NEVATT
Suffix:
Gender:F
Credentials:ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 JURUPA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2221
Mailing Address - Country:US
Mailing Address - Phone:909-227-4800
Mailing Address - Fax:951-787-7865
Practice Address - Street 1:3833 JURUPA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2221
Practice Address - Country:US
Practice Address - Phone:909-227-4800
Practice Address - Fax:951-787-7865
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ110770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist