Healthcare Provider Details

I. General information

NPI: 1104483148
Provider Name (Legal Business Name): ANGELA DAWN LYGREN LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA DAWN LYGREN LM, CPM

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 NE 8TH ST STE 115
BELLEVUE WA
98007-4115
US

IV. Provider business mailing address

3701 173RD PL SW
LYNNWOOD WA
98037-7536
US

V. Phone/Fax

Practice location:
  • Phone: 206-719-2409
  • Fax:
Mailing address:
  • Phone: 206-719-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60939330
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: