Provider Demographics
NPI:1053479733
Name:REVENO, LYNNE K (RN CNS)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:K
Last Name:REVENO
Suffix:
Gender:F
Credentials:RN CNS
Other - Prefix:
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Mailing Address - Street 1:8 MEADOWVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2913
Mailing Address - Country:US
Mailing Address - Phone:617-957-7944
Mailing Address - Fax:781-665-7543
Practice Address - Street 1:1 W FOSTER ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3810
Practice Address - Country:US
Practice Address - Phone:617-957-7944
Practice Address - Fax:781-665-7543
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA101852163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult