Basic Information
Provider Information
NPI: 1104264522
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LYNCH
FirstName: RUTH
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2411 FOUNTAIN VIEW DR
Address2: STE. 200
City: HOUSTON
State: TX
PostalCode: 770574817
CountryCode: US
TelephoneNumber: 7136204000
FaxNumber:  
Practice Location
Address1: 2411 FOUNTAIN VIEW DR
Address2: STE. 200
City: HOUSTON
State: TX
PostalCode: 770574817
CountryCode: US
TelephoneNumber: 7136204000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2013
LastUpdateDate: 09/09/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X835898TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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