Provider Demographics
NPI:1063788925
Name:LYNN, MOIRA (PA-C, FNP)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:PA-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 E RANCHO VISTA DR
Mailing Address - Street 2:#1008
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1348
Mailing Address - Country:US
Mailing Address - Phone:480-245-6765
Mailing Address - Fax:
Practice Address - Street 1:1 E CAMELBACK RD
Practice Address - Street 2:#550
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1668
Practice Address - Country:US
Practice Address - Phone:619-993-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 17175174H00000X
CA19135363A00000X
AZCC-0836101YP2500X
AZAP0884363LF0000X, 363LA2200X
AZAP0035364SP0808X
AZ1630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174H00000XOther Service ProvidersHealth Educator
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health