Provider Demographics
NPI:1902060080
Name:MAUPIN, LYNN LOUISE (PMHNP-BC, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:LOUISE
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7294
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0639
Mailing Address - Country:US
Mailing Address - Phone:623-760-7660
Mailing Address - Fax:567-243-7800
Practice Address - Street 1:251 N ESTRELLA PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9334
Practice Address - Country:US
Practice Address - Phone:623-760-7660
Practice Address - Fax:567-243-7800
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3084363LA2200X, 363LG0600X, 363LP2300X
AZAP4302363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ353173Medicaid
AZ353173Medicaid