Provider Demographics
NPI:1225494198
Name:LYNCH, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 STILES RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 STILES RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4879
Practice Address - Country:US
Practice Address - Phone:603-898-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NH1147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant