Provider Demographics
NPI:1952407744
Name:CAPPELLUCCI, LYNNE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:CAPPELLUCCI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:MARIE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:400 BENEDICTA AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2099
Mailing Address - Country:US
Mailing Address - Phone:719-846-2206
Mailing Address - Fax:
Practice Address - Street 1:400 BENEDICTA AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2099
Practice Address - Country:US
Practice Address - Phone:719-846-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171347363LF0000X
AZAP2570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily