Provider Demographics
NPI:1932286473
Name:LYNCH, MARY PAT (RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PAT
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:NUTRITION AND FOOD SERVICE (120)
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-3862
Mailing Address - Fax:317-988-2358
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:NUTRITION AND FOOD SERVICE (120)
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-3862
Practice Address - Fax:317-988-2358
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
357688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered