Healthcare Provider Details

I. General information

NPI: 1013158773
Provider Name (Legal Business Name): MS. LYNNETTE J CROMWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 COLLEGE AVE
SANTA ROSA CA
95401-5117
US

IV. Provider business mailing address

1359 ORSOLINI PL
SANTA ROSA CA
95403-7219
US

V. Phone/Fax

Practice location:
  • Phone: 707-568-2800
  • Fax: 707-568-2804
Mailing address:
  • Phone: 707-321-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: