MEDICARE: MRS. CAROLYN NAGEL LYN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	18698	CA

General Provider Information

NPI Number	:	1093872988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN NAGEL LYN PA-C

Provider Business Mailing Address
First Line	:	19162 YACHT LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-2124
Country	:	US
Telephone Number	:	714-721-6356
Fax Number	:

Provider Business Practice Location Address
First Line	:	18582 BEACH BLVD STE 23A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2012
Country	:	US
Telephone Number	:	714-964-4448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	04/03/2010

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