MEDICARE: MS. JILLIAN ANGIER LYNCH LM, CPM

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	176B00000X	Midwife	LM363	CA
2	176B00000X	Midwife	09064R	NM

General Provider Information

NPI Number	:	1548580947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILLIAN ANGIER LYNCH LM, CPM

Provider Business Mailing Address
First Line	:	14 WORK AVE
Second Line	:
City	:	DEL REY OAKS
State	:	CA
Zip	:	93940-5534
Country	:	US
Telephone Number	:	831-620-2768
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 WORK AVE
Second Line	:
City	:	DEL REY OAKS
State	:	CA
Zip	:	93940-5534
Country	:	US
Telephone Number	:	831-620-2768
Fax Number	:

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	07/30/2013

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