Healthcare Provider Details

I. General information

NPI: 1306365598
Provider Name (Legal Business Name): LINDSAY MARIE NOFZIGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY MARIE GOSSACK

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 570
RENTON WA
98055
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 ATTN CREDENTIALING
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3489
  • Fax: 425-690-9089
Mailing address:
  • Phone: 425-690-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60671576
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN60671576
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60794615
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60794615
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: