MEDICARE: LYNN ST. COEUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1730419110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN ST. COEUR

Provider Business Mailing Address
First Line	:	1505 15TH ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5606
Country	:	US
Telephone Number	:	810-982-2597
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 MILITARY ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5416
Country	:	US
Telephone Number	:	810-985-5437
Fax Number	:	800-248-1568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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