Provider Demographics
NPI:1336185529
Name:LYNCH, MARJORIE MCDANIEL (FNP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:MCDANIEL
Last Name:LYNCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:541-984-4301
Mailing Address - Fax:
Practice Address - Street 1:200 N MONROE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4243
Practice Address - Country:US
Practice Address - Phone:541-686-1427
Practice Address - Fax:541-341-1693
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99007230N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262445Medicaid
ORRR PTAN 500021776Medicare PIN
ORR110602Medicare PIN
OR262445Medicaid