Provider Demographics
NPI:1336184209
Name:VANAMBURG, LYNN GAIL
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:GAIL
Last Name:VANAMBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:GAIL
Other - Last Name:STAGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3487 S LINDEN RD
Mailing Address - Street 2:SUITE R
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3025
Mailing Address - Country:US
Mailing Address - Phone:810-213-1011
Mailing Address - Fax:810-230-0679
Practice Address - Street 1:3487 S LINDEN RD
Practice Address - Street 2:SUITE R
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3025
Practice Address - Country:US
Practice Address - Phone:810-213-1011
Practice Address - Fax:810-230-0679
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002214237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC30681OtherBCBSM PIN