Provider Demographics
NPI:1154332906
Name:MASSARO, LYNNE MARIE (DNP, ANP-BC, FNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:MASSARO
Suffix:
Gender:F
Credentials:DNP, ANP-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2513
Mailing Address - Country:US
Mailing Address - Phone:585-698-0021
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE BOX SON
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-276-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02632300Medicaid
NYRA5971OtherMEDICARE ID
NY02632300Medicaid