Provider Demographics
NPI:1952378853
Name:LYMAN, CAROLE C (NP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:C
Last Name:LYMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PRESCOTT ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2610
Mailing Address - Country:US
Mailing Address - Phone:508-753-7259
Mailing Address - Fax:508-753-9577
Practice Address - Street 1:85 PRESCOTT ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2610
Practice Address - Country:US
Practice Address - Phone:508-753-7259
Practice Address - Fax:508-753-9577
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA83701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0975OtherBLUE SHIELD HMO BLUE
NP0975OtherBLUE CARE ELECT
NP0975OtherBLUE SHIELD INDEMNITY
NP0975OtherBLUE SHIELD HMO BLUE
NP0975OtherBLUE CARE ELECT
NP0975Medicare ID - Type Unspecified