Provider Demographics
NPI:1740262492
Name:MCGRORY, LYNN E (CRNP)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:E
Last Name:MCGRORY
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 1:671 GOODLETTE FRANK RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5469
Mailing Address - Country:US
Mailing Address - Phone:239-331-7782
Mailing Address - Fax:239-331-7786
Practice Address - Street 1:671 GOODLETTE FRANK RD
Practice Address - Street 2:SUITE 160
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5469
Practice Address - Country:US
Practice Address - Phone:239-331-7782
Practice Address - Fax:239-331-7786
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004601U363LC0200X
FLARNP9255998363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02452Medicare UPIN
075181Medicare ID - Type Unspecified