Healthcare Provider Details

I. General information

NPI: 1982852844
Provider Name (Legal Business Name): LYNNANN PFAUTSCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 STACKYARD DR
MASTIC BEACH NY
11951-1407
US

IV. Provider business mailing address

51 STACKYARD DR
MASTIC BEACH NY
11951-1407
US

V. Phone/Fax

Practice location:
  • Phone: 631-772-2098
  • Fax:
Mailing address:
  • Phone: 631-772-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number567739-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: