Healthcare Provider Details

I. General information

NPI: 1235961236
Provider Name (Legal Business Name): LYNNE MARIE HORODYSKI NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

3123 LOWINGSIDE DR
JENISON MI
49428-8781
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2670
  • Fax: 517-364-3994
Mailing address:
  • Phone: 616-915-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number4704244475
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: