Provider Demographics
NPI:1154339554
Name:LYNE, LORI A (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:LYNE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1619
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:2377 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1254
Practice Address - Country:US
Practice Address - Phone:413-596-5550
Practice Address - Fax:413-794-2551
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA203116363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS85655Medicare UPIN