Healthcare Provider Details

I. General information

NPI: 1407562820
Provider Name (Legal Business Name): LYNNA VO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WILLOW DR
GRETNA LA
70053-4860
US

IV. Provider business mailing address

28 WILLOW DR
GRETNA LA
70053-4860
US

V. Phone/Fax

Practice location:
  • Phone: 504-473-3712
  • Fax:
Mailing address:
  • Phone: 504-473-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: