Provider Demographics
NPI:1659438414
Name:LYNCH, MARYELLEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9206 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1722
Mailing Address - Country:US
Mailing Address - Phone:301-587-8264
Mailing Address - Fax:
Practice Address - Street 1:1 DISCOVERY PL
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3354
Practice Address - Country:US
Practice Address - Phone:240-662-2273
Practice Address - Fax:240-662-1909
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner