Healthcare Provider Details

I. General information

NPI: 1487836482
Provider Name (Legal Business Name): LYNN ANNETTE HANDY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

V. Phone/Fax

Practice location:
  • Phone: 765-655-2583
  • Fax: 765-655-2661
Mailing address:
  • Phone: 765-655-2583
  • Fax: 765-655-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28103327A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: