Provider Demographics
NPI:1740532159
Name:BEATTY, LYNN E (TEACHER)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:E
Last Name:BEATTY
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16015 LYNCH RD
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-9326
Mailing Address - Country:US
Mailing Address - Phone:585-590-6906
Mailing Address - Fax:
Practice Address - Street 1:16015 LYNCH RD
Practice Address - Street 2:
Practice Address - City:HOLLEY
Practice Address - State:NY
Practice Address - Zip Code:14470-9326
Practice Address - Country:US
Practice Address - Phone:585-590-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist