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General NPI Number Information
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NPI Number | 1588803431
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Entity Type | Individual
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Provider Name | LYNNE BASDEN VINSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 07/09/2011
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Provider Practice Location Address
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Address Line | 3803 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27455-2593
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Country | US
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Telephone | 919-810-2805
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 EDGEWATER DR
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City | GARNER
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State | NC
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Zip | 27529-7158
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Country | US
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Telephone | 919-810-2805
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5004261
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License Number State | NC
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