Provider Demographics
NPI:1720253073
Name:SOPER, LYNNE P (CRNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:P
Last Name:SOPER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:87 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4427
Mailing Address - Country:US
Mailing Address - Phone:301-694-0606
Mailing Address - Fax:301-662-6928
Practice Address - Street 1:87 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4427
Practice Address - Country:US
Practice Address - Phone:301-694-0606
Practice Address - Fax:301-662-6928
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN34605363LP0200X
MDR106802363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics