Healthcare Provider Details

I. General information

NPI: 1679863021
Provider Name (Legal Business Name): LAUREN ANNELIESE ENGELMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21616 76TH AVE W STE 113
EDMONDS WA
98026-7512
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-4636
  • Fax: 425-673-3953
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD60961321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: