Provider Demographics
NPI:1912967704
Name:VIGIL, LYNNE A (NP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:A
Last Name:VIGIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:806 S PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5541
Mailing Address - Country:US
Mailing Address - Phone:928-468-8603
Mailing Address - Fax:928-468-8625
Practice Address - Street 1:806 S PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5541
Practice Address - Country:US
Practice Address - Phone:928-468-8603
Practice Address - Fax:928-468-8625
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146507Medicaid
R14507Medicare UPIN
AZ146507Medicaid