Provider Demographics
NPI:1184636482
Name:LYNCH, MARCIA THERESA (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:THERESA
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 SW BARNES RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6623
Mailing Address - Country:US
Mailing Address - Phone:503-297-6334
Mailing Address - Fax:503-297-2360
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-297-6334
Practice Address - Fax:503-297-2360
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080012183N1-FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500008424OtherUNITED HEALTHCARE
OR049887Medicaid
OR104662Medicare ID - Type Unspecified
OR500008424OtherUNITED HEALTHCARE