Provider Demographics
NPI:1457977092
Name:LYNCH, VICKI L (RN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10596 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:RADISSON
Mailing Address - State:WI
Mailing Address - Zip Code:54867-7065
Mailing Address - Country:US
Mailing Address - Phone:715-558-3501
Mailing Address - Fax:
Practice Address - Street 1:6571 AFTERHOUR RD
Practice Address - Street 2:
Practice Address - City:BRULE
Practice Address - State:WI
Practice Address - Zip Code:54820
Practice Address - Country:US
Practice Address - Phone:608-383-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI239084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse