Provider Demographics
NPI:1043355043
Name:CARR, LYNETTE LEA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:LEA
Last Name:CARR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SAMPSON ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6539
Mailing Address - Country:US
Mailing Address - Phone:716-488-1639
Mailing Address - Fax:
Practice Address - Street 1:10714 NORTH RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14129-9746
Practice Address - Country:US
Practice Address - Phone:716-287-3734
Practice Address - Fax:716-287-3740
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5046471163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse