Provider Demographics
NPI:1861815037
Name:LYNCH, MICHAEL JUDE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUDE
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 W RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1444
Mailing Address - Country:US
Mailing Address - Phone:907-538-2290
Mailing Address - Fax:
Practice Address - Street 1:2136 W RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1444
Practice Address - Country:US
Practice Address - Phone:907-538-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60445519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health