Healthcare Provider Details

I. General information

NPI: 1265954820
Provider Name (Legal Business Name): MARILYN MARIE LYNCH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 COLONEL GLENN ROAD
LITTLE ROCK AR
72204
US

IV. Provider business mailing address

7723 COLONEL GLENN RD
LITTLE ROCK AR
72204-7503
US

V. Phone/Fax

Practice location:
  • Phone: 501-280-9195
  • Fax: 501-664-2488
Mailing address:
  • Phone: 501-280-9195
  • Fax: 501-664-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL10358
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: