MEDICARE: MS. LYN M STEVENS

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	172V00000X	Community Health Worker	685257298 MCD	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760787105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYN M STEVENS

Provider Business Mailing Address
First Line	:	395 SE PIUTE WAY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-3935
Country	:	US
Telephone Number	:	386-984-6759
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 SE PIUTE WAY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-3935
Country	:	US
Telephone Number	:	386-984-6759
Fax Number	:

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

Provider Enumeration Date	:	01/16/2011
Last Update Date	:	01/16/2011

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