Provider Demographics
NPI:1366726432
Name:NUSSBAUM, LYNN M (CPNP)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CROSS ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4647
Mailing Address - Country:US
Mailing Address - Phone:203-229-2000
Mailing Address - Fax:203-840-9001
Practice Address - Street 1:40 CROSS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4647
Practice Address - Country:US
Practice Address - Phone:203-229-2000
Practice Address - Fax:203-840-9001
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004821363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008043922Medicaid