Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DE00007633 | WA |
NPI | 1154545259 |
---|---|
Provider Name | Susan Lynne |
First Address | Seattle, WA 98101-1736 |
Second Address | Seattle, WA 98101-1736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |