Healthcare Provider Details

I. General information

NPI: 1093960478
Provider Name (Legal Business Name): LYNN M TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN DIOTALEVI APRN

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MAIN ST
MIDDLETOWN CT
06457-2718
US

IV. Provider business mailing address

675 MAIN ST
MIDDLETOWN CT
06457-2718
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax: 860-343-7379
Mailing address:
  • Phone: 860-347-6971
  • Fax: 860-343-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3846
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003846
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: