Healthcare Provider Details

I. General information

NPI: 1447455878
Provider Name (Legal Business Name): LYNNE ANNE BRADY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HILLMONT AVE
VENTURA CA
93003-1647
US

IV. Provider business mailing address

3071 PALO VERDE CIR
SANTA ROSA VALLEY CA
93012-8219
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5755
  • Fax: 805-652-5765
Mailing address:
  • Phone: 805-491-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number256746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: