=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568096485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYN PATUSKY MSN, RN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2020
-----------------------------------------------------
Last Update Date | 03/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 E PALMER RD
-----------------------------------------------------
City | BELLEFONTAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43311-2281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-592-4039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6961 STATE ROUTE 56
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43044-9719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-504-7794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.026115
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------