1316038656 NPI number — ANN MARIE KEEFER-LYNCH NP

Table of content: ANN MARIE KEEFER-LYNCH NP (NPI 1316038656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316038656 NPI number — ANN MARIE KEEFER-LYNCH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEEFER-LYNCH
Provider First Name:
ANN MARIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316038656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3615 BANYON RIM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORBA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92886-6916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-693-8400
Provider Business Mailing Address Fax Number:
714-744-8630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-771-8000
Provider Business Practice Location Address Fax Number:
714-744-8630
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  357126 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NPF 9809 . This is a "NP FURNISHING # -- FOR WRITING PRESCRIPTIONS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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