Healthcare Provider Details

I. General information

NPI: 1528311941
Provider Name (Legal Business Name): LYNN ANN VANAIRSDALE DO, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

252 DAHLIA AVE
IMPERIAL BEACH CA
91932-1906
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1725
  • Fax:
Mailing address:
  • Phone: 608-215-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0102205768
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number554-55
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: