Provider Demographics
NPI:1447455878
Name:BRADY, LYNNE ANNE (RN)
Entity type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:ANNE
Last Name:BRADY
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 1:3071 PALO VERDE CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8219
Mailing Address - Country:US
Mailing Address - Phone:805-491-2606
Mailing Address - Fax:
Practice Address - Street 1:200 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1647
Practice Address - Country:US
Practice Address - Phone:805-652-5755
Practice Address - Fax:805-652-5765
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256746163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health