MEDICARE: MS. LYNNE CAMILLE GAFFORD CNP

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	4704137078	MI

General Provider Information

NPI Number	:	1497754816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNNE CAMILLE GAFFORD CNP

Provider Business Mailing Address
First Line	:	747 EASTBRIDGE CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4534
Country	:	US
Telephone Number	:	248-705-3139
Fax Number	:

Provider Business Practice Location Address
First Line	:	6777 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3013
Country	:	US
Telephone Number	:	248-325-1099
Fax Number	:	248-325-1610

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	10/24/2017

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