Healthcare Provider Details

I. General information

NPI: 1083036982
Provider Name (Legal Business Name): JACQUELINE ANN LYNCH CPM, RM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 MONACO ST
HENDERSON CO
80640
US

IV. Provider business mailing address

PO BOX 2064
BOULDER CO
80306-2064
US

V. Phone/Fax

Practice location:
  • Phone: 720-724-7664
  • Fax:
Mailing address:
  • Phone: 720-724-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMWR.0000162
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: