Provider Demographics
NPI:1730320904
Name:JAMISON, LYNN MARIE (CRNP, DNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:CRNP, DNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-1723
Mailing Address - Country:US
Mailing Address - Phone:724-770-9095
Mailing Address - Fax:724-770-9096
Practice Address - Street 1:176 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1723
Practice Address - Country:US
Practice Address - Phone:724-770-9095
Practice Address - Fax:724-770-9096
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025180220002Medicaid
PA1025180220002Medicaid