Provider Demographics
NPI:1982852844
Name:PFAUTSCH, LYNNANN (RN)
Entity Type:Individual
Prefix:
First Name:LYNNANN
Middle Name:
Last Name:PFAUTSCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 STACKYARD DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-1407
Mailing Address - Country:US
Mailing Address - Phone:631-772-2098
Mailing Address - Fax:
Practice Address - Street 1:51 STACKYARD DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1407
Practice Address - Country:US
Practice Address - Phone:631-772-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567739-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02868995Medicaid