Provider Demographics
NPI:1124343330
Name:HALL, LYNN MCINTOSH (ANP)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MCINTOSH
Last Name:HALL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12235 BAJADA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2055
Mailing Address - Country:US
Mailing Address - Phone:619-708-9129
Mailing Address - Fax:
Practice Address - Street 1:3250 FORDHAM ST BLDG A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5339
Practice Address - Country:US
Practice Address - Phone:619-221-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456780363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health