MEDICARE: LYNN GRAFFEO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00645500	NJ

General Provider Information

NPI Number	:	1154771400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN GRAFFEO FNP

Provider Business Mailing Address
First Line	:	1973 SPRINGFIELD AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3435
Country	:	US
Telephone Number	:	973-313-2501
Fax Number	:	973-313-2505

Provider Business Practice Location Address
First Line	:	1973 SPRINGFIELD AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3435
Country	:	US
Telephone Number	:	973-313-2501
Fax Number	:	973-313-2505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	06/20/2016

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