Provider Demographics
NPI:1720768377
Name:LYNCH, ARDITH (RN)
Entity type:Individual
Prefix:
First Name:ARDITH
Middle Name:
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:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:SALYER
Mailing Address - State:CA
Mailing Address - Zip Code:95563-0420
Mailing Address - Country:US
Mailing Address - Phone:707-616-3624
Mailing Address - Fax:
Practice Address - Street 1:3750 ROHNERVILLE RD
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3118
Practice Address - Country:US
Practice Address - Phone:707-725-6101
Practice Address - Fax:707-725-2978
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4723367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse