Provider Demographics
NPI:1215951876
Name:FOLLOWELL, LYNN M (APN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:FOLLOWELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MCPHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2831
Mailing Address - Country:US
Mailing Address - Phone:618-241-1360
Mailing Address - Fax:618-241-1865
Practice Address - Street 1:1501 MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2831
Practice Address - Country:US
Practice Address - Phone:618-241-1360
Practice Address - Fax:618-241-1865
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00345209OtherRR MEDICARE NUMBER
ILCE9335OtherRR GROUP NUMBER
ILP00345209OtherRR MEDICARE NUMBER
ILP43765Medicare UPIN