Provider Demographics
NPI:1629074927
Name:PHILLIPS, LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:190 BRODHEAD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8617
Mailing Address - Country:US
Mailing Address - Phone:610-694-9090
Mailing Address - Fax:610-861-8295
Practice Address - Street 1:190 BRODHEAD RD STE 101
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-694-9090
Practice Address - Fax:610-861-8295
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000123821363LF0000X
PASP008979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP34172Medicare UPIN