Healthcare Provider Details

I. General information

NPI: 1497754816
Provider Name (Legal Business Name): LYNNE CAMILLE GAFFORD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

747 EASTBRIDGE CT
ROCHESTER HILLS MI
48307-4534
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1099
  • Fax: 248-325-1610
Mailing address:
  • Phone: 248-705-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704137078
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: