Provider Demographics
NPI:1770850182
Name:LYNCH, COLLEEN ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ELLEN
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 1:1040 CONKLIN RD
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13748-1136
Mailing Address - Country:US
Mailing Address - Phone:607-775-9136
Mailing Address - Fax:607-775-9142
Practice Address - Street 1:1040 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:CONKLIN
Practice Address - State:NY
Practice Address - Zip Code:13748-1136
Practice Address - Country:US
Practice Address - Phone:607-775-9136
Practice Address - Fax:607-775-9142
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380383163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool