MEDICARE: MRS. LYNNE VANZETTA-GRANT

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	163W00000X	Registered Nurse	482983-1	NY

General Provider Information

NPI Number	:	1649658493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNNE VANZETTA-GRANT

Provider Business Mailing Address
First Line	:	97 BAYVIEW AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-4307
Country	:	US
Telephone Number	:	631-669-8654
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 BAYVIEW AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-4307
Country	:	US
Telephone Number	:	631-669-8654
Fax Number	:

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

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	05/13/2015

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Directions to “ MRS. LYNNE VANZETTA-GRANT ” Practice Location

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