Provider Demographics
NPI:1255750097
Name:LYNCH, MICHAEL JAMES (R,DN, RCEP, CDE, CH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:LYNCH
Suffix:
Gender:M
Credentials:R,DN, RCEP, CDE, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21813 84TH AVE W UNIT B
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7820
Mailing Address - Country:US
Mailing Address - Phone:509-481-0884
Mailing Address - Fax:
Practice Address - Street 1:21813 84TH AVE W UNIT B
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7820
Practice Address - Country:US
Practice Address - Phone:509-481-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1043196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered