MEDICARE: SHANNON ALEXIS LYNCH RN

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	364SA2100X	Acute Care Clinical Nurse Specialist	4704244756	MI

General Provider Information

NPI Number	:	1528560349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ALEXIS LYNCH RN

Provider Business Mailing Address
First Line	:	26594 OLD HOMESTEAD DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3843
Country	:	US
Telephone Number	:	248-939-4981
Fax Number	:

Provider Business Practice Location Address
First Line	:	26594 OLD HOMESTEAD DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3843
Country	:	US
Telephone Number	:	248-939-4981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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