Provider Demographics
NPI:1376711226
Name:LYNCH, DEBBIE G
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:G
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 1:616 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-5259
Mailing Address - Country:US
Mailing Address - Phone:918-227-2406
Mailing Address - Fax:918-227-2406
Practice Address - Street 1:616 S PARK ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5259
Practice Address - Country:US
Practice Address - Phone:918-227-2406
Practice Address - Fax:918-227-2406
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor