Provider Demographics
NPI:1730545567
Name:LIFECYCLES HEALTH SERVICES INC
Entity type:Organization
Organization Name:LIFECYCLES HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:BRONZELL-WYNDER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,CRNP,NP-C,ANP-BC
Authorized Official - Phone:856-288-9115
Mailing Address - Street 1:433 N 7TH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-2212
Mailing Address - Country:US
Mailing Address - Phone:856-288-9115
Mailing Address - Fax:856-379-4286
Practice Address - Street 1:433 N 7TH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-2212
Practice Address - Country:US
Practice Address - Phone:856-288-9115
Practice Address - Fax:856-379-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-09
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008348261Q00000X
PASP013200363LC1500X
NJ26NJ00600900363LF0000X
PAVP004088G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ533933ZWUPMedicare PIN