Provider Demographics
NPI:1881102580
Name:PHILLEY, LYNNE KATHLEEN (NP-C)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:KATHLEEN
Last Name:PHILLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4237
Mailing Address - Country:US
Mailing Address - Phone:315-338-7308
Mailing Address - Fax:315-338-7422
Practice Address - Street 1:1819 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2451
Practice Address - Country:US
Practice Address - Phone:315-338-7184
Practice Address - Fax:315-339-1975
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308500-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health