MEDICARE: JENNIFER MARIE ANDERSON LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA00022662	WA

General Provider Information

NPI Number	:	1023166238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE ANDERSON LMP

Provider Business Mailing Address
First Line	:	8320 LAKE CITY WAY NE
Second Line	:	#106
City	:	SEATTLE
State	:	WA
Zip	:	98115-4414
Country	:	US
Telephone Number	:	425-652-2207
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 LAKE CITY WAY NE
Second Line	:	#106
City	:	SEATTLE
State	:	WA
Zip	:	98115-4414
Country	:	US
Telephone Number	:	425-652-2207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	11/10/2008

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