Individual
LYNNE MCILVAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPAC
Contact information
Practice address
5794 WIDEWATERS PKWY, SYRACUSE, NY 13214-1845
(315) 422-1513
(315) 422-5890
Mailing address
5794 WIDEWATERS PKWY, SYRACUSE, NY 13214-1845
(315) 422-1513
(315) 422-5890
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001720
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01286680
—
NY
Enumeration date
01/31/2006
Last updated
12/10/2020
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