Provider Demographics
NPI:1497751028
Name:LYNN, PHYLLIS (CNM)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-6813
Mailing Address - Fax:718-283-8468
Practice Address - Street 1:6208 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4616
Practice Address - Country:US
Practice Address - Phone:718-283-8867
Practice Address - Fax:718-283-8468
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000129-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07793568Medicaid
NYR96434Medicare UPIN
NY07793568Medicaid