Basic Information
| Provider Information | |||||||||
| NPI: | 1003945098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANLIEW | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN,BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2289 BRENGARE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300334711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043298573 | ||||||||
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| Practice Location | |||||||||
| Address1: | 450 WINN WAY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042940449 | ||||||||
| FaxNumber: | 4042940793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | RN087348 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.