MEDICARE: LYNNE T WORDEN RN

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	163W00000X	Registered Nurse	381003-1	NY

General Provider Information

NPI Number	:	1538628144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE T WORDEN RN

Provider Business Mailing Address
First Line	:	6854 N CHASES LAKE RD
Second Line	:
City	:	GLENFIELD
State	:	NY
Zip	:	13343-2110
Country	:	US
Telephone Number	:	315-771-0441
Fax Number	:

Provider Business Practice Location Address
First Line	:	6537 JOHNSON RD
Second Line	:
City	:	GLENFIELD
State	:	NY
Zip	:	13343-4120
Country	:	US
Telephone Number	:	315-783-9474
Fax Number	:

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

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	03/14/2019

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