Healthcare Provider Details

I. General information

NPI: 1346001682
Provider Name (Legal Business Name): LALAINE JANE FAJARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 NE 128TH ST
KIRKLAND WA
98034-7208
US

IV. Provider business mailing address

11800 NE 128TH ST
KIRKLAND WA
98034-7208
US

V. Phone/Fax

Practice location:
  • Phone: 425-417-5119
  • Fax:
Mailing address:
  • Phone: 425-595-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN60389862
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: