1306080007 NPI number — MS. LYNN TEEPLE DEROCCO RN

Table of content: MS. LYNN TEEPLE DEROCCO RN (NPI 1306080007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306080007 NPI number — MS. LYNN TEEPLE DEROCCO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEROCCO
Provider First Name:
LYNN
Provider Middle Name:
TEEPLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306080007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 RED HILL CIR APT L
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIBURON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94920-1729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-789-1335
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 CLEMENT ST
Provider Second Line Business Practice Location Address:
SAN FRANCISCO VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94121-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-221-4810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  313161 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)