Healthcare Provider Details

I. General information

NPI: 1538628144
Provider Name (Legal Business Name): LYNNE T WORDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6537 JOHNSON RD
GLENFIELD NY
13343-4120
US

IV. Provider business mailing address

6854 N CHASES LAKE RD
GLENFIELD NY
13343-2110
US

V. Phone/Fax

Practice location:
  • Phone: 315-783-9474
  • Fax:
Mailing address:
  • Phone: 315-771-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number381003-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: