Provider Demographics
NPI:1477665172
Name:FORMOSA, LYNDA R (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:R
Last Name:FORMOSA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15043
Mailing Address - Country:US
Mailing Address - Phone:724-573-4648
Mailing Address - Fax:
Practice Address - Street 1:331 SHAW AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2918
Practice Address - Country:US
Practice Address - Phone:412-675-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily