Healthcare Provider Details

I. General information

NPI: 1326376914
Provider Name (Legal Business Name): LYNNETTE MARSHALL GIFFIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHNSON RD SUITE 200
STEUBENVILLE OH
43952-2356
US

IV. Provider business mailing address

4100 JOHNSON RD SUITE 200
STEUBENVILLE OH
43952-2356
US

V. Phone/Fax

Practice location:
  • Phone: 740-266-8004
  • Fax: 740-266-8005
Mailing address:
  • Phone: 740-266-8004
  • Fax: 740-266-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA05073NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberCOA04189NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: