Provider Demographics
NPI:1083199400
Name:FELTON, LYNNEA (NMD)
Entity type:Individual
Prefix:
First Name:LYNNEA
Middle Name:
Last Name:FELTON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1301
Mailing Address - Country:US
Mailing Address - Phone:602-900-9103
Mailing Address - Fax:866-452-2709
Practice Address - Street 1:18275 N 59TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1252
Practice Address - Country:US
Practice Address - Phone:602-900-9103
Practice Address - Fax:866-452-2709
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1751175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath