Provider Demographics
NPI:1053414292
Name:LYNCH, NANCY ARLENE (ARNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ARLENE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ARLENE
Other - Last Name:HICKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-335-7017
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-335-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ-113539363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04605OtherWELLMARK BCBS
IAI20413Medicare PIN
IA04605OtherWELLMARK BCBS