Healthcare Provider Details

I. General information

NPI: 1629545132
Provider Name (Legal Business Name): KERRY LYNN METZGER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

2600 SW HOLDEN ST
SEATTLE WA
98126-3505
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6606
  • Fax: 206-257-6830
Mailing address:
  • Phone: 206-933-7000
  • Fax: 206-933-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00047681
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: