Healthcare Provider Details

I. General information

NPI: 1003536186
Provider Name (Legal Business Name): LYNDA LOHSE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

IV. Provider business mailing address

445 OAK AVE
STATEN ISLAND NY
10306-4519
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2588
  • Fax:
Mailing address:
  • Phone: 917-647-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number758410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: