MEDICARE: MRS. LYNN RENEE BROOKS 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	MA60113279	WA

General Provider Information

NPI Number	:	1023315736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN RENEE BROOKS LMP

Provider Business Mailing Address
First Line	:	4305 LAKE WASHINGTON BLVD NE
Second Line	:	2311
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7883
Country	:	US
Telephone Number	:	360-298-4695
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 LAKE WASHINGTON BLVD NE
Second Line	:	2311
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7883
Country	:	US
Telephone Number	:	360-298-4695
Fax Number	:

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

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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