Healthcare Provider Details

I. General information

NPI: 1821375056
Provider Name (Legal Business Name): LYNN M SLIDER CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7008 WHIPPLE RD
LOUISVILLE KY
40272-4742
US

IV. Provider business mailing address

7008 WHIPPLE RD
LOUISVILLE KY
40272-4742
US

V. Phone/Fax

Practice location:
  • Phone: 502-724-0821
  • Fax:
Mailing address:
  • Phone: 502-724-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA223
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: