Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO00000797 | WA |
NPI | 1225058035 |
---|---|
Provider Name | Dr. Jessica Lea Lund |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201-4833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 13/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2009313 | (05) | WA |