Provider Demographics
NPI:1578702932
Name:LYNCH, SANDRA GRACE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GRACE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5649
Mailing Address - Country:US
Mailing Address - Phone:806-353-6095
Mailing Address - Fax:
Practice Address - Street 1:3919 FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5649
Practice Address - Country:US
Practice Address - Phone:806-353-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse