Provider Demographics
NPI:1770709354
Name:HJALMERVIK, LYNNETTE MARIE (CNS,NP)
Entity type:Individual
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First Name:LYNNETTE
Middle Name:MARIE
Last Name:HJALMERVIK
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Gender:F
Credentials:CNS,NP
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Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:5030 W MCDOWELL RD
Practice Address - Street 2:SUITE 16
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-3945
Practice Address - Country:US
Practice Address - Phone:602-278-1414
Practice Address - Fax:602-269-8410
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN134980, AP2336363LA2200X
AZRN134980, AP2337363LP0808X
MNR 091048-8364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ400584Medicaid
AZ400584Medicaid