Provider Demographics
NPI:1144717067
Name:ULEVICH, LYNNE BARBARA (PA-C)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:BARBARA
Last Name:ULEVICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 VILLA RAFAEL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6075
Mailing Address - Country:US
Mailing Address - Phone:702-845-4392
Mailing Address - Fax:
Practice Address - Street 1:9310 S EASTERN AVE STE 122
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6844
Practice Address - Country:US
Practice Address - Phone:702-489-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102798363A00000X
NVPA834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant