Healthcare Provider Details

I. General information

NPI: 1912475872
Provider Name (Legal Business Name): LILIA LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BIRADAN ANAKKO
DEDEDO GU
96929-5739
US

IV. Provider business mailing address

PO BOX 290952
YIGO GU
96929-3045
US

V. Phone/Fax

Practice location:
  • Phone: 671-645-5500
  • Fax:
Mailing address:
  • Phone: 671-688-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP0192
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: