Provider Demographics
NPI:1033107396
Name:MONFREDA, LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:MONFREDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-514-6300
Mailing Address - Fax:978-514-6324
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-514-6300
Practice Address - Fax:978-514-6324
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MANP9917363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9917OtherSTATE LICENSE