Basic Information
Provider Information
NPI: 1003802216
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDREWS
FirstName: LYNN
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1000
Address2:  
City: DYER
State: IN
PostalCode: 463110800
CountryCode: US
TelephoneNumber: 2199332270
FaxNumber: 2198522515
Practice Location
Address1: 5454 HOHMAN AVE
Address2:  
City: HAMMOND
State: IN
PostalCode: 463201931
CountryCode: US
TelephoneNumber: 2199332270
FaxNumber: 2198522515
Other Information
ProviderEnumerationDate: 09/22/2005
LastUpdateDate: 02/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X28158485AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
20007869005IN MEDICAID


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