MEDICARE: LYNN RENAY PARKER 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	363LA2200X	Adult Health Nurse Practitioner	26NJ00084000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477604205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN RENAY PARKER NP

Provider Business Mailing Address
First Line	:	284 E LAKE AVE
Second Line	:
City	:	RAHWAY
State	:	NJ
Zip	:	07065-4942
Country	:	US
Telephone Number	:	732-259-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 BERGEN ST
Second Line	:	SUITE 1118
City	:	NEWARK
State	:	NJ
Zip	:	07107-3001
Country	:	US
Telephone Number	:	973-972-8946
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	01/09/2012

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