=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942824917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYDIA HILLIER PELTIER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2020
-----------------------------------------------------
Last Update Date | 01/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18100 NE UNION HILL RD FL 2
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-3330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-881-5437
-----------------------------------------------------
Fax | 425-947-4521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25608
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84125-0608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-320-4476
-----------------------------------------------------
Fax | 206-568-7043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD61395873
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------