Provider Demographics
NPI:1346869583
Name:DEMATTEO, LYNDSAY (MSN, APRN, AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:DEMATTEO
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:1ST FLOOR WELD BLDG
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6402
Practice Address - Fax:401-455-6405
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT153756163W00000X
CTAG06200113363LG0600X
RIAPRN02654363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse