Healthcare Provider Details

I. General information

NPI: 1740359942
Provider Name (Legal Business Name): LYNN H OGDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

3901 HOYT AVE
EVERETT WA
98201-4918
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30001819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: