Provider Demographics
NPI:1265546865
Name:FRYER, LYNN (APN-C)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:FRYER
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BISHOP PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1178
Mailing Address - Country:US
Mailing Address - Phone:732-932-7402
Mailing Address - Fax:732-932-8255
Practice Address - Street 1:11 BISHOP PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1178
Practice Address - Country:US
Practice Address - Phone:732-932-7402
Practice Address - Fax:732-932-8255
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN11840600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122973XVAMedicare UPIN