Provider Demographics
NPI:1912962135
Name:PEOPLES, LYNNETTE K (APN-BC)
Entity type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:K
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 RIVER BIRCH CIR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1690
Mailing Address - Country:US
Mailing Address - Phone:609-724-7862
Mailing Address - Fax:
Practice Address - Street 1:252 ROUTE 601
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-3923
Practice Address - Country:US
Practice Address - Phone:908-281-1000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ00033200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064742Medicaid
NJ092019Medicare ID - Type Unspecified
NJQ46356Medicare UPIN