Provider Demographics
NPI:1215575261
Name:SMITH, LYNN SARA (RN,NP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:SARA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 WELLELEIN RD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3215
Mailing Address - Country:US
Mailing Address - Phone:516-456-7163
Mailing Address - Fax:
Practice Address - Street 1:8712 175TH ST UNIT 2A
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5776
Practice Address - Country:US
Practice Address - Phone:718-360-0907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383036363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics