Healthcare Provider Details

I. General information

NPI: 1386293561
Provider Name (Legal Business Name): EMILY JANE LIPPOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 AIRPORT WAY S
SEATTLE WA
98134-1618
US

IV. Provider business mailing address

1700 AIRPORT WAY S
SEATTLE WA
98134-1618
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-3644
  • Fax:
Mailing address:
  • Phone: 206-223-3644
  • Fax: 206-223-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAP6094553
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60945553
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP6094553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: