Provider Demographics
NPI:1780665919
Name:DICUS, LYNN ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:DICUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4579
Mailing Address - Country:US
Mailing Address - Phone:731-642-0025
Mailing Address - Fax:731-644-0899
Practice Address - Street 1:305 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4579
Practice Address - Country:US
Practice Address - Phone:731-642-0025
Practice Address - Fax:731-644-0899
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 5352363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903166Medicaid
500011931OtherRAILROAD MEDICARE
TN3903167Medicare PIN
500011931OtherRAILROAD MEDICARE
TNS82248Medicare UPIN