Provider Demographics
NPI:1851309108
Name:LYMAN, KATHERINE STEVENS (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:STEVENS
Last Name:LYMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4440
Mailing Address - Country:US
Mailing Address - Phone:978-263-2747
Mailing Address - Fax:
Practice Address - Street 1:110 FRANCIS ST
Practice Address - Street 2:DIVISION OF GERONTOLOGY LMOB-1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-8696
Practice Address - Fax:617-632-8673
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151955363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705811Medicaid
MA20490Medicare ID - Type UnspecifiedHMFP GROUP
MA0705811Medicaid