Healthcare Provider Details

I. General information

NPI: 1225452667
Provider Name (Legal Business Name): LYNETTE DAVIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 OLD PHILADELPHIA PIKE
LANCASTER PA
17602-2633
US

IV. Provider business mailing address

1641 OLD PHILADELPHIA PIKE
LANCASTER PA
17602-2633
US

V. Phone/Fax

Practice location:
  • Phone: 717-358-2919
  • Fax:
Mailing address:
  • Phone: 717-358-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN261842L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberSP007156
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: