Provider Demographics
NPI:1356460661
Name:DIAS, LYNNETTE J (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:J
Last Name:DIAS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4725
Mailing Address - Country:US
Mailing Address - Phone:508-746-0318
Mailing Address - Fax:
Practice Address - Street 1:27 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4725
Practice Address - Country:US
Practice Address - Phone:508-746-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234140163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704776Medicaid