Provider Demographics
NPI:1609262526
Name:ENDSLEY, LYNELLE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:LYNELLE
Middle Name:MARIE
Last Name:ENDSLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LYNELLE
Other - Middle Name:
Other - Last Name:ENDSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP-CNP
Mailing Address - Street 1:400 N PENNSYLVANIA AVE
Mailing Address - Street 2:STE 570
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4792
Mailing Address - Country:US
Mailing Address - Phone:770-455-4009
Mailing Address - Fax:770-455-4065
Practice Address - Street 1:400 N PENNSYLVANIA AVE
Practice Address - Street 2:STE 570
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4792
Practice Address - Country:US
Practice Address - Phone:575-625-5512
Practice Address - Fax:575-625-1013
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56101363LF0000X
GARN2295514363LF0000X
NMCNP-56101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily