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NPI Code Detail

MEDICARE: MS. NINA A. HOLIDAY-LYNCH LP

MEDICARE: MS. NINA A. HOLIDAY-LYNCH LP
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
1103T00000XPsychologist3584MN

General Provider Information

NPI Number : 1336248053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NINA A. HOLIDAY-LYNCH LP
Provider Business Mailing Address
First Line : 4360 BROOKSIDE CT
Second Line : 201
City : EDINA
State : MN
Zip : 55436-1468
Country : US
Telephone Number : 952-947-0834
Fax Number :
Provider Business Practice Location Address
First Line : 4432 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3519
Country : US
Telephone Number : 612-871-0118
Fax Number : 612-870-2403
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/08/2007

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