Healthcare Provider Details

I. General information

NPI: 1043348964
Provider Name (Legal Business Name): LYNN P FRONK SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TEXAS ST NE HAYES MS
ALBUQUERQUE NM
87110-7814
US

IV. Provider business mailing address

1100 TEXAS ST NE HAYES MS
ALBUQUERQUE NM
87110-7814
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-7741
  • Fax:
Mailing address:
  • Phone: 505-265-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI 6006
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI 6006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: