MEDICARE: LORI A LYNE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	203116	MA

General Provider Information

NPI Number	:	1154339554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI A LYNE NP

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST
Second Line	:	2ND FLOOR
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1619
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2377 BOSTON RD
Second Line	:
City	:	WILBRAHAM
State	:	MA
Zip	:	01095-1254
Country	:	US
Telephone Number	:	413-596-5550
Fax Number	:	413-794-2551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	01/21/2014

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