1366584807 NPI number — MS. LYNDA MARIE MORELLI APRN

Table of content: MS. LYNDA MARIE MORELLI APRN (NPI 1366584807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366584807 NPI number — MS. LYNDA MARIE MORELLI APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORELLI
Provider First Name:
LYNDA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANNETTA
Provider Other First Name:
LYNDA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366584807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7074 MAYFAIR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALBOTT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37877-8528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-475-2120
Provider Business Mailing Address Fax Number:
855-544-2120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 N HIGHWAY 92
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37760-3687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-475-2120
Provider Business Practice Location Address Fax Number:
855-544-2120
Provider Enumeration Date:
02/13/2007

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: 363LF0000X , with the licence number:  12749 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12749 . This is a "TN APN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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