Provider Demographics
NPI:1811046576
Name:LYNCH, MARY KATHERINE (CFNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHERINE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNP
Mailing Address - Street 1:4617 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-2107
Mailing Address - Country:US
Mailing Address - Phone:703-243-4382
Mailing Address - Fax:202-522-1746
Practice Address - Street 1:1818 H ST NW
Practice Address - Street 2:MC C2-208
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20433-0001
Practice Address - Country:US
Practice Address - Phone:202-458-0827
Practice Address - Fax:202-522-1746
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN63670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4415990Medicaid
DC583898Medicare UPIN
DC4415990Medicaid