Basic Information
Provider Information
NPI: 1821315383
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NORMAND
FirstName: LYNN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 345 BLACKSTONE BLVD
Address2: WELD BUILDING
City: PROVIDENCE
State: RI
PostalCode: 029064800
CountryCode: US
TelephoneNumber: 8003703651
FaxNumber: 8605100020
Practice Location
Address1: 20 RESEARCH PKWY STE C
Address2:  
City: OLD SAYBROOK
State: CT
PostalCode: 064754214
CountryCode: US
TelephoneNumber: 8003703651
FaxNumber: 8605100020
Other Information
ProviderEnumerationDate: 04/23/2010
LastUpdateDate: 04/23/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN28793RIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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