Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OP 00001398 | WA |
NPI | 1235195066 |
---|---|
Provider Name | Judith Lee Lewis |
First Address | Mukilteo, WA 98275-1581 |
Second Address | Mukilteo, WA 98275-1581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0032958 | LABOR AND INDUSTRY (01) | WA |
A94768 | (02) | |
LE9113 | REGENCE BLUE SHIELD (01) | WA |