Provider Demographics
NPI:1235465717
Name:SHREVE, LYNN M (RN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:SHREVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6331
Mailing Address - Country:US
Mailing Address - Phone:607-319-0938
Mailing Address - Fax:
Practice Address - Street 1:115 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-6331
Practice Address - Country:US
Practice Address - Phone:607-319-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568292-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse