Healthcare Provider Details

I. General information

NPI: 1992718464
Provider Name (Legal Business Name): RIZWANNA LOTT PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIZWANA JABEEN PA-C

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE
EVERETT WA
98201-1665
US

IV. Provider business mailing address

19020 33RD AVE W STE 210
LYNNWOOD WA
98036-4748
US

V. Phone/Fax

Practice location:
  • Phone: 425-404-5200
  • Fax:
Mailing address:
  • Phone: 425-563-1500
  • Fax: 425-563-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004918
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: