Healthcare Provider Details

I. General information

NPI: 1942119839
Provider Name (Legal Business Name): ELEXIS MARIEA LEMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 WHEATON WAY
BREMERTON WA
98310-3435
US

IV. Provider business mailing address

4525 W JARSTAD DR
BREMERTON WA
98312-5055
US

V. Phone/Fax

Practice location:
  • Phone: 360-627-8547
  • Fax:
Mailing address:
  • Phone: 360-627-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCOWS.PR.70168480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: