Basic Information
| Provider Information | |||||||||
| NPI: | 1093263873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LASSEN | ||||||||
| FirstName: | KAITLIN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11695 NE 4TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980045268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256371855 | ||||||||
| FaxNumber: | 2063447970 | ||||||||
| Practice Location | |||||||||
| Address1: | 11695 NE 4TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980045268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256371855 | ||||||||
| FaxNumber: | 2063447970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2016 | ||||||||
| LastUpdateDate: | 12/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9110458 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.