=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740534924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN COFFEY RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2012
-----------------------------------------------------
Last Update Date | 11/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18007 57TH AVE NE
-----------------------------------------------------
City | KENMORE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98028-4528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-550-9656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 82156
-----------------------------------------------------
City | KENMORE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98028-0156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-550-9656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH 00005312
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------