Provider Demographics
NPI:1265701437
Name:FREDA, LYNN MARIE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MARIE
Last Name:FREDA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:TAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:830 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 306 MOB NORTH
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3118
Mailing Address - Country:US
Mailing Address - Phone:484-592-3000
Mailing Address - Fax:484-592-3009
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:SUITE 306 MOB NORTH
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:484-592-3000
Practice Address - Fax:484-592-3009
Is Sole Proprietor?:No
Enumeration Date:2011-12-17
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily