Provider Demographics
NPI:1164478517
Name:LYNCH, COLLEEN S (APRN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:S
Last Name:LYNCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-692-6676
Mailing Address - Fax:603-692-0919
Practice Address - Street 1:85 MAIN STREET
Practice Address - Street 2:SOMERSWORTH PLAZA
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-3129
Practice Address - Country:US
Practice Address - Phone:603-692-6676
Practice Address - Fax:603-692-0919
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH025810-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1164478517Medicaid
NH3077230Medicaid
NH3077230Medicaid
NHP29263Medicare UPIN