Provider Demographics
NPI:1760462303
Name:LYNCH, SUSAN R (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:LYNCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GLENWOOD DRIVE
Mailing Address - Street 2:SUITE E-788
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-7117
Mailing Address - Country:US
Mailing Address - Phone:423-495-3940
Mailing Address - Fax:423-495-3949
Practice Address - Street 1:725 GLENWOOD DRIVE
Practice Address - Street 2:SUITE E-788
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-7117
Practice Address - Country:US
Practice Address - Phone:423-495-3940
Practice Address - Fax:423-495-3949
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104402163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3649772Medicare ID - Type Unspecified