Provider Demographics
NPI:1346800521
Name:DUTKOWSKY, LYNNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:
Last Name:DUTKOWSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S BENITA BLVD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2675
Mailing Address - Country:US
Mailing Address - Phone:607-757-2313
Mailing Address - Fax:607-757-3725
Practice Address - Street 1:600 S BENITA BLVD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2675
Practice Address - Country:US
Practice Address - Phone:607-757-2313
Practice Address - Fax:607-757-3725
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY371007-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6077857076Medicaid