1619054814 NPI number — MS. GERALDINE BRENDA LYMAN CRNA

Table of content: MS. GERALDINE BRENDA LYMAN CRNA (NPI 1619054814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619054814 NPI number — MS. GERALDINE BRENDA LYMAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYMAN
Provider First Name:
GERALDINE
Provider Middle Name:
BRENDA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1619054814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 3925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59722-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-585-9662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N WILLSON AVE
Provider Second Line Business Practice Location Address:
SAME DAY SURGERY CENTER
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59715-3551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-585-9662
Provider Business Practice Location Address Fax Number:
406-587-7656
Provider Enumeration Date:
11/01/2006

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: 367500000X , with the licence number:  RN9328 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000091095 BC . This is a "CRNA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0439433 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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