Healthcare Provider Details

I. General information

NPI: 1265190847
Provider Name (Legal Business Name): NATALIE GORDON LYNCH NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 S 17TH ST
WILMINGTON NC
28401-7515
US

IV. Provider business mailing address

2212 S 17TH ST
WILMINGTON NC
28401-7515
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-2970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5009708
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5009708
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: