Provider Demographics
NPI:1407974140
Name:REID, LYNN I (NP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:I
Last Name:REID
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:I
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 US ROUTE 1
Mailing Address - Street 2:BREAST CARE CENTER
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9302
Mailing Address - Country:US
Mailing Address - Phone:207-885-7760
Mailing Address - Fax:
Practice Address - Street 1:100 US ROUTE 1
Practice Address - Street 2:BREAST CARE CENTER
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9302
Practice Address - Country:US
Practice Address - Phone:207-885-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER050667363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344084Medicaid
ME432088599Medicaid
ME432088599Medicaid