Provider Demographics
NPI:1942502109
Name:NUTI, LYNN A
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:A
Last Name:NUTI
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 1:16 FORGE POND
Mailing Address - Street 2:UNIT D
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2995
Mailing Address - Country:US
Mailing Address - Phone:617-947-0102
Mailing Address - Fax:
Practice Address - Street 1:16 FORGE POND
Practice Address - Street 2:UNIT D
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2995
Practice Address - Country:US
Practice Address - Phone:617-947-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN195904363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health