Provider Demographics
NPI:1043477607
Name:SMITH, LYNNE C (ANP)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON STREET
Mailing Address - Street 2:SSMC
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:90 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3129
Practice Address - Country:US
Practice Address - Phone:781-682-5900
Practice Address - Fax:781-331-1763
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103228363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherMULTI-PLAN
MA0729744Medicaid
042297845OtherTRICARE
MANP9321, SS0060OtherBCBSMA
042297845OtherGREAT WEST HEALTH CARE
1043477607OtherFALLON HEALTH CARE
MA0729744Medicaid