Provider Demographics
NPI:1326583659
Name:JONES, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1120
Mailing Address - Country:US
Mailing Address - Phone:315-723-2662
Mailing Address - Fax:
Practice Address - Street 1:227 W SENECA ST
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1120
Practice Address - Country:US
Practice Address - Phone:315-723-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006612-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY461371314OtherEIN