Provider Demographics
NPI:1275601536
Name:CODY, LYNN ROBERTA (APRN, BC, NP, CDE)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ROBERTA
Last Name:CODY
Suffix:
Gender:F
Credentials:APRN, BC, NP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC INC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8000
Mailing Address - Fax:
Practice Address - Street 1:LAHEY CLINIC
Practice Address - Street 2:41 MALL RD
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-5100
Practice Address - Fax:978-538-4712
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0399761Medicaid
MA0399761Medicaid
MANP1176Medicare ID - Type Unspecified