Basic Information
Provider Information
NPI: 1326179409
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LYNCH
FirstName: REBECCA
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: DEPARTMENT 888182
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379958182
CountryCode: US
TelephoneNumber: 8003553565
FaxNumber: 4237142355
Practice Location
Address1: 815 WEST FIFTH NORTH STREET
Address2:  
City: MORRISTOWN
State: TN
PostalCode: 37814
CountryCode: US
TelephoneNumber: 4235865032
FaxNumber: 4235818473
Other Information
ProviderEnumerationDate: 03/08/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0808XRN51918TNY Nursing Service ProvidersRegistered NursePsych/Mental Health

No ID Information.


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