Provider Demographics
NPI:1265954820
Name:LYNCH, MARILYN MARIE (LPN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARIE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7723 COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7503
Mailing Address - Country:US
Mailing Address - Phone:501-280-9195
Mailing Address - Fax:501-664-2488
Practice Address - Street 1:7723 COLONEL GLENN ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204
Practice Address - Country:US
Practice Address - Phone:501-280-9195
Practice Address - Fax:501-664-2488
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL10358163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171460795Medicaid