Healthcare Provider Details

I. General information

NPI: 1831689132
Provider Name (Legal Business Name): LYNN GUIMOND MACKINSON RN MS ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEACONESS RD
BOSTON MA
02215-5321
US

IV. Provider business mailing address

1 DEACONESS RD
BOSTON MA
02215-5321
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-8743
  • Fax:
Mailing address:
  • Phone: 617-632-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN161370
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN161370
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: