Provider Demographics
NPI:1134408586
Name:PURVIS, LYNDA JEAN (CDC I)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:JEAN
Last Name:PURVIS
Suffix:
Gender:F
Credentials:CDC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 LAKEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7719
Mailing Address - Country:US
Mailing Address - Phone:907-347-1622
Mailing Address - Fax:
Practice Address - Street 1:1521 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6203
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness