Provider Demographics
NPI:1922360080
Name:ALLEN, LYNNETTE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 WALT WHITMAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2216
Mailing Address - Country:US
Mailing Address - Phone:516-294-6200
Mailing Address - Fax:888-522-2854
Practice Address - Street 1:734 WALT WHITMAN RD STE 104
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2216
Practice Address - Country:US
Practice Address - Phone:516-294-6200
Practice Address - Fax:888-522-2854
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305980-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health