Healthcare Provider Details

I. General information

NPI: 1336184209
Provider Name (Legal Business Name): MRS. LYNN GAIL VANAMBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN GAIL STAGMAN

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3487 S LINDEN RD SUITE R
FLINT MI
48507-3025
US

IV. Provider business mailing address

3487 S LINDEN RD SUITE R
FLINT MI
48507-3025
US

V. Phone/Fax

Practice location:
  • Phone: 810-213-1011
  • Fax: 810-230-0679
Mailing address:
  • Phone: 810-213-1011
  • Fax: 810-230-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501002214
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: