1659376549 NPI number — LYNDA KAREN DOULIN CRNP

Table of content: MARTIN SNYDER (NPI 1558910133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659376549 NPI number — LYNDA KAREN DOULIN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOULIN
Provider First Name:
LYNDA
Provider Middle Name:
KAREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOULIN
Provider Other First Name:
LYNDA KAREN
Provider Other Middle Name:
SEYMOUR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659376549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDALUSIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36420-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-222-0184
Provider Business Mailing Address Fax Number:
334-222-0625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDALUSIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36420-4732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-222-0184
Provider Business Practice Location Address Fax Number:
334-222-0625
Provider Enumeration Date:
06/16/2005

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: 363LP0200X , with the licence number:  1-061198 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 1-061198 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000020702 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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