Healthcare Provider Details

I. General information

NPI: 1114459062
Provider Name (Legal Business Name): SERENA LYNCH CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 2ND ST STE 337
DULUTH MN
55802-1928
US

IV. Provider business mailing address

205 W 2ND ST STE 337
DULUTH MN
55802-1928
US

V. Phone/Fax

Practice location:
  • Phone: 218-576-5439
  • Fax:
Mailing address:
  • Phone: 218-576-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number1053
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: