Provider Demographics
NPI:1639126055
Name:ADDIE, LYNN ELLEN (CRNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:ADDIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:RIPORTELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-782-3380
Mailing Address - Fax:717-782-5716
Practice Address - Street 1:1995 TECHNOLOGY PKWY
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-8522
Practice Address - Country:US
Practice Address - Phone:717-782-3380
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006619B363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2677086OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA1602875OtherGATEWAY MEDICARE ASSURED
PA102654131Medicaid
PAP21405Medicare UPIN