Provider Demographics
NPI:1417467937
Name:ROBERTS, LYNNE ANN (DNP, CRNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:ANN
Other - Last Name:PASIERB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CRNP
Mailing Address - Street 1:62 GREENBRIAR DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-8209
Mailing Address - Country:US
Mailing Address - Phone:724-845-7765
Mailing Address - Fax:724-845-8418
Practice Address - Street 1:62 GREENBRIAR DR STE 1
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656
Practice Address - Country:US
Practice Address - Phone:724-845-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034501720001Medicaid
PA14196700OtherCAQH