Provider Demographics
NPI:1073114500
Name:NULL, LYNNSEY NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:LYNNSEY
Middle Name:NICOLE
Last Name:NULL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DRIVE SUITE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:401 YOUNG AVE STE 325
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-4800
Practice Address - Country:US
Practice Address - Phone:856-291-8865
Practice Address - Fax:856-291-8880
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022616363LW0102X
NJ26NJ01077000363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health