Healthcare Provider Details

I. General information

NPI: 1962070862
Provider Name (Legal Business Name): LYNN MARIE MACMASTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460C NAUGATUCK AVE
MILFORD CT
06460-5049
US

IV. Provider business mailing address

56 WHALLEY AVE
MILFORD CT
06460-7865
US

V. Phone/Fax

Practice location:
  • Phone: 203-951-1719
  • Fax: 203-350-6013
Mailing address:
  • Phone: 203-376-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10252
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number74394
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: