Provider Demographics
NPI:1952403784
Name:STUTEVILLE, LYNN GAY (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:GAY
Last Name:STUTEVILLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9412 SUNPERCH CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2886
Mailing Address - Country:US
Mailing Address - Phone:281-412-6794
Mailing Address - Fax:
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-2860
Practice Address - Fax:713-873-2864
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX557327367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109728904Medicaid
TX430064403Medicare PIN
TX85381HMedicare PIN
TX109728904Medicaid
TX8L27574Medicare PIN
TXS31923Medicare UPIN