Provider Demographics
NPI:1720018351
Name:SCARBROUGH, LYNN M (NP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:SCARBROUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3347
Mailing Address - Country:US
Mailing Address - Phone:847-382-6579
Mailing Address - Fax:
Practice Address - Street 1:120 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3347
Practice Address - Country:US
Practice Address - Phone:847-382-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL458110OtherPIN # FOR NORTHWEST COMM.
ILS59539Medicare UPIN