Basic Information
Provider Information | |||||||||
NPI: | 1699049817 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOVEL | ||||||||
FirstName: | LYNN | ||||||||
MiddleName: | ROBIN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN, BSN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PFEIFER | ||||||||
OtherFirstName: | LYNN | ||||||||
OtherMiddleName: | KOVEL | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN, BSN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 3010 GRAND AVE FL 1 | ||||||||
Address2: |   | ||||||||
City: | WAUKEGAN | ||||||||
State: | IL | ||||||||
PostalCode: | 600852321 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8473778950 | ||||||||
FaxNumber: | 8479845602 | ||||||||
Practice Location | |||||||||
Address1: | 3010 GRAND AVE FL 1 | ||||||||
Address2: |   | ||||||||
City: | WAUKEGAN | ||||||||
State: | IL | ||||||||
PostalCode: | 600852321 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8473778950 | ||||||||
FaxNumber: | 8479845602 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/06/2012 | ||||||||
LastUpdateDate: | 03/06/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | 041244438 | IL | Y |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent |
No ID Information.