=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104782333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIERRA LYNN EZRRE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1412 SW 43RD ST STE 140
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-4803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-264-0750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8421 DECOY BLVD
-----------------------------------------------------
City | JUNEAU
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99801-8959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-209-2658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------