Healthcare Provider Details

I. General information

NPI: 1841797883
Provider Name (Legal Business Name): LORENA CAULKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195
US

IV. Provider business mailing address

4245 ROOSEVELT WAY NE # 354760
SEATTLE WA
98105-6008
US

V. Phone/Fax

Practice location:
  • Phone: 267-250-7895
  • Fax:
Mailing address:
  • Phone: 206-598-8750
  • Fax: 206-598-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61081793
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPG215911
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: