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General NPI Number Information
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NPI Number | 1477604205
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Entity Type | Individual
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Provider Name | LYNN RENAY PARKER NP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 65 BERGEN ST SUITE 1118
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City | NEWARK
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State | NJ
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Zip | 07107-3001
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Country | US
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Telephone | 973-972-8946
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Fax |
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Provider Business Mailing Address
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Address Line | 284 E LAKE AVE
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City | RAHWAY
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State | NJ
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Zip | 07065-4942
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Country | US
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Telephone | 732-259-5156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00084000
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License Number State | NJ
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