Provider Demographics
NPI:1740586304
Name:CLYNCH, EMMA RUTH (RN)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:RUTH
Last Name:CLYNCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:CLYNCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:426 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2473
Mailing Address - Country:US
Mailing Address - Phone:651-385-6180
Mailing Address - Fax:651-385-6195
Practice Address - Street 1:426 WEST AVE
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2473
Practice Address - Country:US
Practice Address - Phone:651-385-6180
Practice Address - Fax:651-385-6195
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR107639-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse