Provider Demographics
NPI:1366107864
Name:MIRAVALLES-MAGHUYOP, LYNNIE (RN)
Entity type:Individual
Prefix:
First Name:LYNNIE
Middle Name:
Last Name:MIRAVALLES-MAGHUYOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9151 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1646
Mailing Address - Country:US
Mailing Address - Phone:773-742-5785
Mailing Address - Fax:
Practice Address - Street 1:9151 KENNETH AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1646
Practice Address - Country:US
Practice Address - Phone:773-742-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41.36573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse