Healthcare Provider Details

I. General information

NPI: 1265582480
Provider Name (Legal Business Name): GERALDINE JENNIFER LEE ARNP, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 3RD AVE NE FL 2
SEATTLE WA
98115-2077
US

IV. Provider business mailing address

9709 3RD AVE NE
SEATTLE WA
98115-2062
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-5777
  • Fax: 206-528-9881
Mailing address:
  • Phone: 206-525-5777
  • Fax: 206-528-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60776005
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000306
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: