Provider Demographics
NPI:1043816978
Name:LYNCH, JENNA ANN (RN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:SC
Mailing Address - Zip Code:29591-5524
Mailing Address - Country:US
Mailing Address - Phone:843-373-5039
Mailing Address - Fax:
Practice Address - Street 1:1705 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3331
Practice Address - Country:US
Practice Address - Phone:843-661-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC249714163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health