Provider Demographics
NPI:1114377561
Name:SODERQUIST, LYNN (RN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SODERQUIST
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 1:864 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1418
Mailing Address - Country:US
Mailing Address - Phone:914-413-4116
Mailing Address - Fax:
Practice Address - Street 1:864 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1418
Practice Address - Country:US
Practice Address - Phone:914-413-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY546801163W00000X
FLRN9349279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse