=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265582480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALDINE JENNIFER LEE ARNP, LM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9709 3RD AVE NE FL 2
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98115-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-525-5777
-----------------------------------------------------
Fax | 206-528-9881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9709 3RD AVE NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98115-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-525-5777
-----------------------------------------------------
Fax | 206-528-9881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | MW00000306
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP60776005
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------