Healthcare Provider Details

I. General information

NPI: 1720487598
Provider Name (Legal Business Name): LYNETTE ROSSBACK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5578 LONGLEY LN
RENO NV
89511
US

IV. Provider business mailing address

9460 DOUBLE R BLVD STE 101
RENO NV
89521-4814
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-8650
  • Fax: 775-284-8654
Mailing address:
  • Phone: 775-284-8650
  • Fax: 775-432-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN32209
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN002521
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: