Healthcare Provider Details

I. General information

NPI: 1669600888
Provider Name (Legal Business Name): NATHAN LYNCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 NW CANAL BLVD
REDMOND OR
97756-1334
US

IV. Provider business mailing address

2200 NE NEFF RD #200
BEND OR
97701-4283
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-8131
  • Fax: 541-526-6608
Mailing address:
  • Phone: 541-382-3344
  • Fax: 541-322-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA20373
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA60150184
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA156399
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: