Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MWR.0000162 | CO |
NPI | 1083036982 |
---|---|
Provider Name | Jacqueline Ann Lynch |
First Address | Boulder, CO 80306-2064 |
Second Address | Henderson, CO 80640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2014 |
Last Update Date | 08/10/2018 |