Provider Demographics
NPI:1073845301
Name:SAMPLE-GERDA, LYNN MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MARIE
Last Name:SAMPLE-GERDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:SAMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:803 SCENIC LN
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3874
Mailing Address - Country:US
Mailing Address - Phone:216-524-7944
Mailing Address - Fax:
Practice Address - Street 1:803 SCENIC LN
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-3874
Practice Address - Country:US
Practice Address - Phone:216-524-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 184897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse