Provider Demographics
NPI:1366407850
Name:BRYAN, LYNNE ELLEN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:ELLEN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:LYNNE
Other - Middle Name:ELLEN
Other - Last Name:LABUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:3292 STATE ROUTE 257
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346
Mailing Address - Country:US
Mailing Address - Phone:814-676-1811
Mailing Address - Fax:814-677-3091
Practice Address - Street 1:3292 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:814-676-1811
Practice Address - Fax:814-677-3091
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP002027G363LX0001X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA540106Medicare PIN
PA1991407OtherHIGHMARK
PA540106PAZMedicare PIN
PA540106L5TMedicare PIN
PAEM540106OtherHIGHMARK
PA540106L55Medicare PIN