Provider Demographics
NPI:1952339111
Name:HACKERT, LYNNE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:ANN
Last Name:HACKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:8 MEDICAL PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3107
Practice Address - Country:US
Practice Address - Phone:916-878-4948
Practice Address - Fax:916-878-4952
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82209208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A822090OtherMEDICAL / DHS
CAWA82209AMedicare UPIN