Provider Demographics
NPI:1487963575
Name:PEACE, LYNDA KAY
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:KAY
Last Name:PEACE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LYNDA
Other - Middle Name:KAY
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45 STRAIGHT AND NARROW DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4880
Mailing Address - Country:US
Mailing Address - Phone:307-799-6426
Mailing Address - Fax:307-789-0342
Practice Address - Street 1:45 STRAIGHT AND NARROW DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-4880
Practice Address - Country:US
Practice Address - Phone:307-799-6426
Practice Address - Fax:307-789-0342
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator