Provider Demographics
NPI:1811227556
Name:LYNCH, DIANE (FNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2646
Mailing Address - Country:US
Mailing Address - Phone:973-761-9175
Mailing Address - Fax:973-761-9193
Practice Address - Street 1:400 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2646
Practice Address - Country:US
Practice Address - Phone:973-761-9175
Practice Address - Fax:973-761-9193
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00258600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily