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General NPI Number Information
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NPI Number | 1144474933
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Entity Type | Individual
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Provider Name | JENNIFER LILA LONAC PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 6007 244TH ST SW STE B
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-5427
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Country | US
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Telephone | 425-640-4830
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Fax | 425-640-4885
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Provider Business Mailing Address
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Address Line | PO BOX 25608
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City | SALT LAKE CITY
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State | UT
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Zip | 84125-0608
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Country | US
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Telephone | 206-320-4476
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Fax | 206-233-7489
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60061940
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License Number State | WA
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