Provider Demographics
NPI:1962491555
Name:WHITE, LYNETTE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 BETHMOUR RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3369
Mailing Address - Country:US
Mailing Address - Phone:203-393-1142
Mailing Address - Fax:
Practice Address - Street 1:2340 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3511
Practice Address - Country:US
Practice Address - Phone:203-248-8142
Practice Address - Fax:203-248-7764
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001040363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT31326OtherCONTROLLED SUBSTANCE
CTMW0717910OtherDEA
CT31326OtherCONTROLLED SUBSTANCE