MEDICARE: LYNDE AUBURN GWYN FNP-BC

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	363LF0000X	Family Nurse Practitioner	AP4573	AZ

General Provider Information

NPI Number	:	1649524695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDE AUBURN GWYN FNP-BC

Provider Business Mailing Address
First Line	:	5971 E SENECA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3023
Country	:	US
Telephone Number	:	520-322-0566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 S HOUGHTON RD
Second Line	:	CVS CAREMARK MINUTECLINIC
City	:	TUCSON
State	:	AZ
Zip	:	85730-0000
Country	:	US
Telephone Number	:	520-722-5876
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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