Healthcare Provider Details

I. General information

NPI: 1255750097
Provider Name (Legal Business Name): MICHAEL JAMES LYNCH R,D.N, RCEP, CDE, CH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21813 84TH AVE W UNIT B
EDMONDS WA
98026-7820
US

IV. Provider business mailing address

21813 84TH AVE W UNIT B
EDMONDS WA
98026-7820
US

V. Phone/Fax

Practice location:
  • Phone: 509-481-0884
  • Fax:
Mailing address:
  • Phone: 509-481-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1043196
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: