Individual
MRS. LYNDERA VICKLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1248 GUNN HALL DR STE 102, VIRGINIA BEACH, VA 23454-5757
(757) 637-0189
Mailing address
4021 FOXWOOD DR, VIRGINIA BEACH, VA 23462-5210
(757) 267-5877
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
0019016556
VA
225700000X
Massage Therapist
0019016556
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019016556
VA BOARD OF NURSING DEPARTMENT OF HEALTH PROFESSIONS
VA
05
—
11741888478
—
VA
Enumeration date
05/02/2019
Last updated
05/25/2021
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