Provider Demographics
NPI:1770923609
Name:BURBANK, LYNN MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:BURBANK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:BURBANK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1251 ROSEMONT LN
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3902
Mailing Address - Country:US
Mailing Address - Phone:215-292-1070
Mailing Address - Fax:
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:ST CHRISTOPHER'S HOSPITAL FOR CHILDREN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-427-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006553D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics