1730320904 NPI number — LYNN MARIE JAMISON CRNP, DNP

Table of content: LYNN MARIE JAMISON CRNP, DNP (NPI 1730320904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730320904 NPI number — LYNN MARIE JAMISON CRNP, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMISON
Provider First Name:
LYNN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP, DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHILLIPS
Provider Other First Name:
LYNN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730320904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 VIRGINIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15074-1723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-770-9095
Provider Business Mailing Address Fax Number:
724-770-9096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15074-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-770-9095
Provider Business Practice Location Address Fax Number:
724-770-9096
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP010241 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1025180220002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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