Provider Demographics
NPI:1871600650
Name:STUDEBAKER, LYNNE RICCA (MD)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:RICCA
Last Name:STUDEBAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 E BERRY PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2328
Mailing Address - Country:US
Mailing Address - Phone:303-850-7337
Mailing Address - Fax:303-850-7362
Practice Address - Street 1:7840 E BERRY PL
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2328
Practice Address - Country:US
Practice Address - Phone:303-850-7337
Practice Address - Fax:303-850-7362
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist