Healthcare Provider Details

I. General information

NPI: 1932111853
Provider Name (Legal Business Name): MAUREEN K LYNCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W. FORT STREET
BOISE ID
83702-4598
US

IV. Provider business mailing address

1805 N. 21ST STREET
BOISE ID
83702-0734
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1136
  • Fax: 208-422-1243
Mailing address:
  • Phone: 208-333-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00022690
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: