Provider Demographics
NPI:1669545935
Name:LAWLOR, LYNN (CNP)
Entity type:Individual
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First Name:LYNN
Middle Name:
Last Name:LAWLOR
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Gender:F
Credentials:CNP
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Mailing Address - Street 1:9650 WAYNE RD
Mailing Address - Street 2:BEAUMONT TEEN HEALTH CENTER -ROMULUS
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1551
Mailing Address - Country:US
Mailing Address - Phone:734-942-4857
Mailing Address - Fax:734-942-6734
Practice Address - Street 1:9650 WAYNE RD
Practice Address - Street 2:BEAUMONT TEEN HEATLH CENTER -ROMULUS
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:734-942-4857
Practice Address - Fax:734-942-6734
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-12-22
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Provider Licenses
StateLicense IDTaxonomies
MI4704157927363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3436635Medicaid