Healthcare Provider Details

I. General information

NPI: 1659989085
Provider Name (Legal Business Name): MICHELLE RAE MASTERS-LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SWIERKOS DR
MOUNDSVILLE WV
26041-4209
US

IV. Provider business mailing address

4530 LINCOLN AVE
SHADYSIDE OH
43947-1239
US

V. Phone/Fax

Practice location:
  • Phone: 304-843-0910
  • Fax: 304-843-0912
Mailing address:
  • Phone: 304-843-0910
  • Fax: 304-843-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: