Healthcare Provider Details

I. General information

NPI: 1043419997
Provider Name (Legal Business Name): CHRISTOPHER MATHEW LYNN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W COUNTRY CLUB RD
ROSWELL NM
88201-5209
US

IV. Provider business mailing address

405 W COUNTRY CLUB RD C/O MSO ADMINISTRATION
ROSWELL NM
88201-5209
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-8170
  • Fax:
Mailing address:
  • Phone: 575-624-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3209
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA01061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: