Healthcare Provider Details

I. General information

NPI: 1487635751
Provider Name (Legal Business Name): MARY LYNSCHEFT LEHNER C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MEDICAL WAY
SNELLVILLE GA
30078-2195
US

IV. Provider business mailing address

PO BOX 3559
SUWANEE GA
30024-0993
US

V. Phone/Fax

Practice location:
  • Phone: 770-979-9996
  • Fax:
Mailing address:
  • Phone: 770-979-9996
  • Fax: 770-979-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN141513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: