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General NPI Number Information
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NPI Number | 1679073241
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Entity Type | Individual
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Provider Name | NICHOLAS FAY LYNN PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 740 E OAK ST
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City | MONTICELLO
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State | IA
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Zip | 52310-1745
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Country | US
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Telephone | 319-465-6702
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Fax |
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Provider Business Mailing Address
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Address Line | 2381 GORDON DR
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City | DUBUQUE
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State | IA
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Zip | 52001-8413
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Country | US
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Telephone | 563-590-5128
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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