Basic Information
Provider Information
NPI: 1528184918
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREEMAN
FirstName: LYNNE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 34876
Address2:  
City: SEATTLE
State: WA
PostalCode: 981241876
CountryCode: US
TelephoneNumber: 4256565412
FaxNumber: 4256564096
Practice Location
Address1: 1205 N 10TH ST
Address2: STE A
City: RENTON
State: WA
PostalCode: 980575577
CountryCode: US
TelephoneNumber: 4256564211
FaxNumber: 4256564053
Other Information
ProviderEnumerationDate: 03/21/2007
LastUpdateDate: 09/19/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD00030110WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home