Healthcare Provider Details

I. General information

NPI: 1013635614
Provider Name (Legal Business Name): ANNIE LYNDA HOUENDJOU BADJIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 QUEEN ANNE AVE N
SEATTLE WA
98109-4521
US

IV. Provider business mailing address

2904 83RD AVENUE CT E
EDGEWOOD WA
98371-5598
US

V. Phone/Fax

Practice location:
  • Phone: 206-284-7286
  • Fax:
Mailing address:
  • Phone: 508-333-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61346349
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP61346349
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: