Healthcare Provider Details

I. General information

NPI: 1063457836
Provider Name (Legal Business Name): LYNN A STAZZONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL BWH PARTNERS MULTIPLE SCLEROSIS CENTER
BROOKLINE MA
02445-7224
US

IV. Provider business mailing address

1 BROOKLINE PL BWH PARTNERS MULTIPLE SCLEROSIS CENTER
BROOKLINE MA
02445-7224
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-6550
  • Fax: 617-525-6554
Mailing address:
  • Phone: 617-525-6550
  • Fax: 617-525-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number152869
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: