Healthcare Provider Details

I. General information

NPI: 1730363060
Provider Name (Legal Business Name): SIMONE V LYNCH-SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CENTRE BLVD STE E
MARLTON NJ
08053-4129
US

IV. Provider business mailing address

102E CENTRE BLVD
MARLTON NJ
08053-4129
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-6260
  • Fax: 856-988-6270
Mailing address:
  • Phone: 856-988-6260
  • Fax: 856-988-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NO11426200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: