Basic Information
| Provider Information | |||||||||
| NPI: | 1043477607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | LYNNE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 WASHINGTON STREET | ||||||||
| Address2: | SSMC | ||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 90 LIBBEY INDUSTRIAL PKWY | ||||||||
| Address2: | |||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021893129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816825900 | ||||||||
| FaxNumber: | 7813311763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 103228 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 042297845 | 01 | MULTI-PLAN | OTHER | 0729744 | 05 | MA | MEDICAID | 042297845 | 01 | TRICARE | OTHER | NP9321, SS0060 | 01 | MA | BCBSMA | OTHER | 042297845 | 01 | GREAT WEST HEALTH CARE | OTHER | 1043477607 | 01 | FALLON HEALTH CARE | OTHER |