MEDICARE: LYNETTE O'BANNON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1689008989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE O'BANNON

Provider Business Mailing Address
First Line	:	2837 WOODLAND PARK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1433
Country	:	US
Telephone Number	:	702-762-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2837 WOODLAND PARK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1433
Country	:	US
Telephone Number	:	702-762-8288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	08/23/2013

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Directions to “ LYNETTE O'BANNON ” Practice Location

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