Provider Demographics
NPI:1659698629
Name:LANZILLO, LYN RALSTON (RN)
Entity Type:Individual
Prefix:MS
First Name:LYN
Middle Name:RALSTON
Last Name:LANZILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LYN
Other - Middle Name:LANZILLO
Other - Last Name:CHENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:747 MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5223
Mailing Address - Country:US
Mailing Address - Phone:781-245-3377
Mailing Address - Fax:
Practice Address - Street 1:360 DELAWARE AVE
Practice Address - Street 2:3N
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1620
Practice Address - Country:US
Practice Address - Phone:716-852-5900
Practice Address - Fax:716-852-5913
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY480123163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health