Healthcare Provider Details

I. General information

NPI: 1437339942
Provider Name (Legal Business Name): JENSEN LUND NELSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH JENSEN LUND

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 2ND PLACE NORTH M/S KSC 11-103
KENT WA
98032
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3491
  • Fax: 425-690-9091
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003776
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: