Provider Demographics
NPI:1336023365
Name:VAN HEUKELEM, LYNETTE (LVN)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:VAN HEUKELEM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 ELGIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1839
Mailing Address - Country:US
Mailing Address - Phone:619-988-1008
Mailing Address - Fax:
Practice Address - Street 1:5580 ELGIN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1839
Practice Address - Country:US
Practice Address - Phone:619-988-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN129555164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse