Provider Demographics
NPI:1033161716
Name:WACHTEL, LYNN ANNE (RNP)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANNE
Last Name:WACHTEL
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 PINELEDGE RD.
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828
Mailing Address - Country:US
Mailing Address - Phone:401-949-0301
Mailing Address - Fax:401-456-8890
Practice Address - Street 1:600 MOUNT PLEASANT AVE
Practice Address - Street 2:HEALTH SERVICES
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1924
Practice Address - Country:US
Practice Address - Phone:401-456-8055
Practice Address - Fax:401-456-8890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP 23083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001361Medicaid
RI7001361Medicaid