1902295215 NPI number — MRS. LYNDA PENA HUMAN CPNP, PHMNP

Table of content: MRS. LYNDA PENA HUMAN CPNP, PHMNP (NPI 1902295215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902295215 NPI number — MRS. LYNDA PENA HUMAN CPNP, PHMNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENA HUMAN
Provider First Name:
LYNDA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP, PHMNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUMAN
Provider Other First Name:
LYNDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP, PMHNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902295215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 972733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79997-2733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
999-999-9999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 BOEING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-599-6600
Provider Business Practice Location Address Fax Number:
915-629-2680
Provider Enumeration Date:
01/10/2015

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:  757699 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP127048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP127048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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