Provider Demographics
NPI:1457717738
Name:QUARTLBAUM, LYNETTE (RN)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:QUARTLBAUM
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 1:5006 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-3204
Mailing Address - Country:US
Mailing Address - Phone:757-240-4440
Mailing Address - Fax:757-706-3568
Practice Address - Street 1:5006 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3204
Practice Address - Country:US
Practice Address - Phone:757-240-4440
Practice Address - Fax:757-706-3568
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-03
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-161383374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide