Provider Demographics
NPI:1033157466
Name:LYNN, JOAN (RN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:732-745-7352
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:732-745-2980
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00039300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072079Medicaid
NJ0072079Medicaid
NJQ47066Medicare UPIN