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General NPI Number Information
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NPI Number | 1114519683
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Entity Type | Individual
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Provider Name | GINA LIGHTNER
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Gender | Female
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Dates
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Enumeration Date | 02/06/2021
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 16150 NE 85TH ST STE 115
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City | REDMOND
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State | WA
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Zip | 98052-3541
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Country | US
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Telephone | 425-882-1354
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 NW 56TH ST APT 513
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City | SEATTLE
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State | WA
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Zip | 98107-4459
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Country | US
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Telephone | 774-258-2704
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1859297
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License Number State | MA
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