Provider Demographics
NPI:1770722639
Name:MARTIN, LYNN Y (RN, MS, CS, NP, PMH)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:Y
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, MS, CS, NP, PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 AVENIDA DE ORINDA # 100
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2327
Mailing Address - Country:US
Mailing Address - Phone:925-377-0410
Mailing Address - Fax:925-377-1070
Practice Address - Street 1:61 AVENIDA DE ORINDA # 100
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2327
Practice Address - Country:US
Practice Address - Phone:925-377-0410
Practice Address - Fax:925-377-1070
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 535612364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult