Provider Demographics
NPI:1700097409
Name:BJORNNES, LYNN MARIE (PTA CLT-LANA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:BJORNNES
Suffix:
Gender:F
Credentials:PTA CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1214
Mailing Address - Country:US
Mailing Address - Phone:651-633-3984
Mailing Address - Fax:651-638-9606
Practice Address - Street 1:2960 SNELLING AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2458
Practice Address - Country:US
Practice Address - Phone:651-633-6299
Practice Address - Fax:651-633-6404
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist