Provider Demographics
NPI:1093886889
Name:LYNCH, JEREMY E (CRNA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:E
Last Name:LYNCH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TULANE AVE
Mailing Address - Street 2:HC71
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-5800
Mailing Address - Fax:504-988-1743
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:HC71
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5800
Practice Address - Fax:504-988-1743
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01381367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA59608Medicare PIN