Provider Demographics
NPI:1063902344
Name:HRIVNAK, LYN MORGAN (RN IBCLC LICENSED LC)
Entity type:Individual
Prefix:
First Name:LYN
Middle Name:MORGAN
Last Name:HRIVNAK
Suffix:
Gender:F
Credentials:RN IBCLC LICENSED LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BROOKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-3807
Mailing Address - Country:US
Mailing Address - Phone:704-466-5542
Mailing Address - Fax:
Practice Address - Street 1:116 BROOKSHIRE CT
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-3807
Practice Address - Country:US
Practice Address - Phone:704-466-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC000039163WL0100X
GARN262102163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant