Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 099490 | IA |
NPI | 1013543842 |
---|---|
Provider Name | Logan Lynch |
First Address | Dubuque, IA 52003-9665 |
Second Address | Dubuque, IA 52001-2313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2020 |
Last Update Date | 12/03/2020 |