Healthcare Provider Details

I. General information

NPI: 1811866106
Provider Name (Legal Business Name): JONATHAN GRADY LYNCH EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8339 LAKESHORE CIR APT 3634
INDIANAPOLIS IN
46250-4829
US

IV. Provider business mailing address

8339 LAKESHORE CIR APT 3634
INDIANAPOLIS IN
46250-4829
US

V. Phone/Fax

Practice location:
  • Phone: 317-459-8277
  • Fax:
Mailing address:
  • Phone: 317-459-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0218-1605
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: