Provider Demographics
NPI:1801184346
Name:HALE, LYNN (FNP, NPP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:FNP, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 STATE ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:FABIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13063-8732
Mailing Address - Country:US
Mailing Address - Phone:315-378-9373
Mailing Address - Fax:
Practice Address - Street 1:2515 STATE ROUTE 91
Practice Address - Street 2:
Practice Address - City:FABIUS
Practice Address - State:NY
Practice Address - Zip Code:13063-8732
Practice Address - Country:US
Practice Address - Phone:315-378-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336812-1363LF0000X
NYF401606-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health