Provider Demographics
NPI:1841479177
Name:BRADY, LYNNE ELISSA (LPN)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:ELISSA
Last Name:BRADY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LACROSSE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3631
Mailing Address - Country:US
Mailing Address - Phone:845-225-3738
Mailing Address - Fax:
Practice Address - Street 1:50 LACROSSE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3631
Practice Address - Country:US
Practice Address - Phone:845-225-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241934-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01667385Medicaid