Healthcare Provider Details

I. General information

NPI: 1013348903
Provider Name (Legal Business Name): LYN GREEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYN CABIGAS RN

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LOW CT FL 2
FAIRFIELD CA
94534-9778
US

IV. Provider business mailing address

207 FIESTA WAY
VACAVILLE CA
95688-9562
US

V. Phone/Fax

Practice location:
  • Phone: 707-432-2700
  • Fax:
Mailing address:
  • Phone: 702-481-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN52158
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95051347
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: