Healthcare Provider Details

I. General information

NPI: 1215380209
Provider Name (Legal Business Name): BRITTANY LYNCH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1611 W HARRISON ST STE 400
CHICAGO IL
60612-4861
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-4244
  • Fax:
Mailing address:
  • Phone: 877-632-6637
  • Fax: 708-409-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004679A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005943
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: