Healthcare Provider Details

I. General information

NPI: 1750152948
Provider Name (Legal Business Name): MS. LYNNE ROCHELLE HRICIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. LYNNE DURNELL

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 EXECUTIVE DR STE 240
CRANBERRY TWP PA
16066-6405
US

IV. Provider business mailing address

501 JACKSON BLVD
FREEDOM PA
15042-2842
US

V. Phone/Fax

Practice location:
  • Phone: 724-772-9797
  • Fax: 724-772-3309
Mailing address:
  • Phone: 724-774-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA000946L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1010116
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMA00946L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: