Healthcare Provider Details

I. General information

NPI: 1386601219
Provider Name (Legal Business Name): LYNDA COLLINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32711 LONG NECK RD
MILLSBORO DE
19966-6678
US

IV. Provider business mailing address

PO BOX 495
LEWES DE
19958-0495
US

V. Phone/Fax

Practice location:
  • Phone: 302-945-9730
  • Fax:
Mailing address:
  • Phone: 302-945-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL60A00128
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: