Provider Demographics
NPI:1295574374
Name:CROSS-MACK, LYNNETTE (RN)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:CROSS-MACK
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23069 RETREAT LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-4192
Mailing Address - Country:US
Mailing Address - Phone:757-967-1062
Mailing Address - Fax:757-800-3416
Practice Address - Street 1:614 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-3348
Practice Address - Country:US
Practice Address - Phone:757-967-1062
Practice Address - Fax:757-800-3416
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health