Provider Demographics
NPI:1164670238
Name:RAIMO, LYNN M (NP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:RAIMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2808
Mailing Address - Country:US
Mailing Address - Phone:631-321-8337
Mailing Address - Fax:631-321-9347
Practice Address - Street 1:38 JAMES ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2808
Practice Address - Country:US
Practice Address - Phone:631-321-8337
Practice Address - Fax:631-321-9347
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304932-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health