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General NPI Number Information
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NPI Number | 1659405306
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Entity Type | Individual
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Provider Name | LYNDA BASILE STACK RN
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 06/27/2014
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Provider Practice Location Address
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Address Line | 6043 HOLLYWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90028-5411
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Country | US
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Telephone | 323-337-1770
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Fax | 323-337-1784
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Provider Business Mailing Address
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Address Line | 1406 N BENTON WAY
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City | LOS ANGELES
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State | CA
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Zip | 90026-2217
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Country | US
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Telephone | 323-395-4845
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7723
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License Number State | CA
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