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General NPI Number Information
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NPI Number | 1184846172
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Entity Type | Individual
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Provider Name | LYNETTE DECHRISTOPHER PAC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 2000 MON HEALTH MEDICAL PARK DR SUITE 2300
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City | MORGANTOWN
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State | WV
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Zip | 26505-1134
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Country | US
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Telephone | 304-599-8802
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Fax | 304-599-5607
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Provider Business Mailing Address
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Address Line | PO BOX 1615
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City | MORGANTOWN
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State | WV
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Zip | 26507-1615
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Country | US
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Telephone | 304-599-8802
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Fax | 304-599-5607
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 01151
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License Number State | WV
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