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General NPI Number Information
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NPI Number | 1982745600
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Entity Type | Organization
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Legal Business Name | PORT TOWNSEND FOOT AND ANKLE CLINIC PS
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 204 GAINES ST
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-6902
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Country | US
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Telephone | 360-385-6486
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Fax | 360-385-6486
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Provider Business Mailing Address
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Address Line | PO BOX 11009
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City | OLYMPIA
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State | WA
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Zip | 98508-1009
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Country | US
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Telephone | 360-352-2037
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Fax | 360-352-0637
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA L LUND
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Credential | DPM
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Telephone | 360-385-6486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | PO00000797
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License Number State | WA
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