Provider Demographics
NPI:1053032565
Name:CHAVARRIA, LYNN M (RN,MSN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:CHAVARRIA
Suffix:
Gender:F
Credentials:RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 PATEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-8747
Mailing Address - Country:US
Mailing Address - Phone:229-894-3504
Mailing Address - Fax:
Practice Address - Street 1:3455 PATEVILLE RD
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-8747
Practice Address - Country:US
Practice Address - Phone:229-894-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN109266163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health