Provider Demographics
NPI:1275354573
Name:ROODING, LYNETTE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:MARIE
Last Name:ROODING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LYNETTE
Other - Middle Name:MARIE
Other - Last Name:BURGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17157 THERESA LN
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48164-8809
Mailing Address - Country:US
Mailing Address - Phone:734-775-8633
Mailing Address - Fax:
Practice Address - Street 1:8623 N WAYNE RD STE 104
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:734-469-2770
Practice Address - Fax:734-793-5312
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293289163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse