Provider Demographics
NPI:1417630864
Name:LYNCH, INDIA ROSE
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:ROSE
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 1:6060 EDWARDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-8421
Mailing Address - Country:US
Mailing Address - Phone:937-728-0828
Mailing Address - Fax:
Practice Address - Street 1:6060 EDWARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-8421
Practice Address - Country:US
Practice Address - Phone:937-728-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker