Healthcare Provider Details

I. General information

NPI: 1154584845
Provider Name (Legal Business Name): MRS. LYNDSEY RENEE KIRCHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 ENTERPRISE DR BLDG 1
FAIRFIELD CA
94533-6822
US

IV. Provider business mailing address

153 CANNON DR
TRAVIS AFB CA
94535-1128
US

V. Phone/Fax

Practice location:
  • Phone: 707-425-1799
  • Fax:
Mailing address:
  • Phone: 502-455-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: