Provider Demographics
NPI:1417991365
Name:MEAD, LYNN HOWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:HOWARD
Last Name:MEAD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011-2615
Mailing Address - Country:US
Mailing Address - Phone:610-641-9693
Mailing Address - Fax:610-641-9693
Practice Address - Street 1:1503 N CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2302
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-861-8080
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN152808L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
065878Medicare PIN