MEDICARE: TAWANA D 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	164X00000X	Licensed Vocational Nurse	320314-31	WI

General Provider Information

NPI Number	:	1699340521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWANA D LYNCH

Provider Business Mailing Address
First Line	:	2656 N TEUTONIA AVE UNIT 6362
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-3415
Country	:	US
Telephone Number	:	323-304-6447
Fax Number	:

Provider Business Practice Location Address
First Line	:	2656 N TEUTONIA AVE UNIT 6362
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-3415
Country	:	US
Telephone Number	:	323-304-6447
Fax Number	:

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

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	05/24/2021

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