Provider Demographics
NPI:1376066571
Name:LYNCH, KAITLIN (APN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 JACOBUS DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1711
Mailing Address - Country:US
Mailing Address - Phone:201-788-5950
Mailing Address - Fax:
Practice Address - Street 1:175 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1619
Practice Address - Country:US
Practice Address - Phone:201-943-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00743300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner