MEDICARE: MICHAEL J LYNCH

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60445519	WA

General Provider Information

NPI Number	:	1336565571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J LYNCH

Provider Business Mailing Address
First Line	:	2136 W RIVERSIDE AVE
Second Line	:	APT 101
City	:	SPOKANE
State	:	WA
Zip	:	99201-1444
Country	:	US
Telephone Number	:	509-263-5690
Fax Number	:

Provider Business Practice Location Address
First Line	:	2136 W RIVERSIDE AVE
Second Line	:	APT 101
City	:	SPOKANE
State	:	WA
Zip	:	99201-1444
Country	:	US
Telephone Number	:	509-263-5690
Fax Number	:

Authorized Official
Title or Position	:	PYSCHIATRIC NURSE PRACITITIONER
Name	:	MICHAEL JUDE LYNCH
Credential	:	PMHNP-BC
Telephone Number	:	509-263-5690

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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