Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP60239311 | WA |
NPI | 1003161498 |
---|---|
Provider Name | Melissa Yen-Ching Lo |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98109-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2012 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003161498 | (05) | WA |
8968689 | MEDICARE PIN (01) | WA |