Provider Demographics
NPI:1245249812
Name:STOODLEY, LYNDA ANNE (NP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:ANNE
Last Name:STOODLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 LOMITA BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-257-0508
Mailing Address - Fax:310-325-8109
Practice Address - Street 1:2841 LOMITA BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-257-0508
Practice Address - Fax:310-325-8109
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442946363L00000X
CA13341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP13341DMedicare ID - Type Unspecified
CAWNP13341EMedicare ID - Type Unspecified
CAQ05791Medicare UPIN
CAWNP13341BMedicare ID - Type Unspecified
CAWNP13341FMedicare ID - Type Unspecified
CAWNP13341AMedicare ID - Type Unspecified
CAWNP13341CMedicare ID - Type Unspecified