Provider Demographics
NPI:1720487598
Name:ROSSBACK, LYNETTE (APRN)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:ROSSBACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 DOUBLE R BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4814
Mailing Address - Country:US
Mailing Address - Phone:775-284-8650
Mailing Address - Fax:775-432-2339
Practice Address - Street 1:5578 LONGLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-284-8650
Practice Address - Fax:775-284-8654
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN32209163W00000X
NVAPRN002521363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse