Provider Demographics
NPI:1457712556
Name:LYNCH, MARY ELLEN (MS,NP-C, CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MS,NP-C, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 GABRIEL ARCHER LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2428
Mailing Address - Country:US
Mailing Address - Phone:570-807-7400
Mailing Address - Fax:
Practice Address - Street 1:AMERICAN ADDICTION TREATMENT CENTER
Practice Address - Street 2:12695 MCMANUS BLVD, BDG 2
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-234-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001261360163W00000X
VA0024-173374363LX0001X
VA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology