Provider Demographics
NPI:1609906379
Name:PURA, LYNN MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:PURA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 FATHER DEAN CT
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-0120
Mailing Address - Country:US
Mailing Address - Phone:510-599-7685
Mailing Address - Fax:
Practice Address - Street 1:940 FATHER DEAN CT
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-0120
Practice Address - Country:US
Practice Address - Phone:510-599-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172897163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6350336Medicaid
AZZZZ147627ZMedicare PIN