Provider Demographics
NPI:1780226761
Name:GOODRICH, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14098-9731
Mailing Address - Country:US
Mailing Address - Phone:585-765-5059
Mailing Address - Fax:
Practice Address - Street 1:1385 MURDOCK RD
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:14098-9731
Practice Address - Country:US
Practice Address - Phone:585-765-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169183164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse