Provider Demographics
NPI:1306144977
Name:PEOPLES, LYNDA M (CRNP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 SANSOM ST
Mailing Address - Street 2:STE 239
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5002
Mailing Address - Country:US
Mailing Address - Phone:215-955-6844
Mailing Address - Fax:215-955-2526
Practice Address - Street 1:1020 SANSOM ST
Practice Address - Street 2:STE 239
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5002
Practice Address - Country:US
Practice Address - Phone:215-955-6844
Practice Address - Fax:215-955-2526
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP011273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA236191Medicare PIN