Provider Demographics
NPI:1093926107
Name:LYNCH, HEATHER (RN)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
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 1:778 WINDING RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-7746
Mailing Address - Country:US
Mailing Address - Phone:270-282-0782
Mailing Address - Fax:810-963-2625
Practice Address - Street 1:778 WINDING RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-7746
Practice Address - Country:US
Practice Address - Phone:270-282-0782
Practice Address - Fax:810-963-2625
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN311061163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429296Medicaid