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NPI Code Detail

MEDICARE: LORETTA I. MITCH-LYNN N.P.

MEDICARE: LORETTA I. MITCH-LYNN N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner7018CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17018NPOTHERCALICENSE

General Provider Information

NPI Number : 1245258128
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORETTA I. MITCH-LYNN N.P.
Provider Business Mailing Address
First Line : ONE CVS DRIVE
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 888-771-1874
Fax Number :
Provider Business Practice Location Address
First Line : 4829 CLAIREMONT DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-2706
Country : US
Telephone Number : 858-273-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 11/25/2013

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