Provider Demographics
NPI:1124302096
Name:KEVEKORDES, LYNN ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANN
Last Name:KEVEKORDES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-5664
Mailing Address - Country:US
Mailing Address - Phone:716-807-3854
Mailing Address - Fax:716-807-3858
Practice Address - Street 1:195 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-5664
Practice Address - Country:US
Practice Address - Phone:716-807-3854
Practice Address - Fax:716-807-3858
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse