Basic Information
| Provider Information | |||||||||
| NPI: | 1710066477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MELVILLE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 MADISON ST STE 1150 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063863400 | ||||||||
| FaxNumber: | 2063863411 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 MADISON ST STE 1150 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063863400 | ||||||||
| FaxNumber: | 2063863411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD00035251 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1017057 | 05 | WA | MEDICAID |