Provider Demographics
NPI:1346657087
Name:LYNCH, JESSIE (LPN)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:MONGAUP VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12762-0293
Mailing Address - Country:US
Mailing Address - Phone:845-707-5329
Mailing Address - Fax:
Practice Address - Street 1:3709 STATE RT. 55
Practice Address - Street 2:
Practice Address - City:KAUNEONGA LAKE
Practice Address - State:NY
Practice Address - Zip Code:12749
Practice Address - Country:US
Practice Address - Phone:845-707-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314723-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse