Provider Demographics
NPI:1629521109
Name:PARKER, LYNN A (FNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1436
Mailing Address - Country:US
Mailing Address - Phone:217-285-2113
Mailing Address - Fax:217-285-4788
Practice Address - Street 1:1700 PARKWAY PLAZA DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2896
Practice Address - Country:US
Practice Address - Phone:309-451-2080
Practice Address - Fax:309-451-2082
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily