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NPI Code Detail

MEDICARE: LYNN M PENFOLD NPC

MEDICARE: LYNN M PENFOLD NPC
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
1363LF0000XFamily Nurse Practitioner4704210483MI

General Provider Information

NPI Number : 1912276502
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN M PENFOLD NPC
Provider Business Mailing Address
First Line : 225 E 5TH ST
Second Line : SUITE 300
City : FLINT
State : MI
Zip : 48502-1641
Country : US
Telephone Number : 810-406-4246
Fax Number : 810-424-6029
Provider Business Practice Location Address
First Line : 5710 CLIO RD
Second Line :
City : FLINT
State : MI
Zip : 48504-1525
Country : US
Telephone Number : 810-787-4445
Fax Number : 810-787-4491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2011
Last Update Date : 01/08/2021

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