Provider Demographics
NPI:1124810262
Name:VERSACE, LYNNE KATHERINE (RN)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:KATHERINE
Last Name:VERSACE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 LANG RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2428
Mailing Address - Country:US
Mailing Address - Phone:248-980-1665
Mailing Address - Fax:
Practice Address - Street 1:4473 PEPPERMILL LN
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2071
Practice Address - Country:US
Practice Address - Phone:248-931-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131522163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse