Healthcare Provider Details

I. General information

NPI: 1598119646
Provider Name (Legal Business Name): JENNIFER BROOKE LUGINBILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENA BROOKE LUGINBILL

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15418 MAIN ST STE 200
MILL CREEK WA
98012-9030
US

IV. Provider business mailing address

7600 EVERGREEN WAY
EVERETT WA
98203-6421
US

V. Phone/Fax

Practice location:
  • Phone: 425-225-8002
  • Fax: 425-225-8021
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60945858
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: