Provider Demographics
NPI:1396295960
Name:LYNN, MARK ANTHONY JR (RN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:LYNN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:926 CARTER DR
Mailing Address - Street 2:
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451
Mailing Address - Country:US
Mailing Address - Phone:251-275-4135
Mailing Address - Fax:251-275-2862
Practice Address - Street 1:926 CARTER DRIVE
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451
Practice Address - Country:US
Practice Address - Phone:251-275-4135
Practice Address - Fax:251-275-2862
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156196163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse