MEDICARE: HEIDI J TEMPLE 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	MA00019283	WA

General Provider Information

NPI Number	:	1184842080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI J TEMPLE LMP

Provider Business Mailing Address
First Line	:	PO BOX 34
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-0034
Country	:	US
Telephone Number	:	425-208-5048
Fax Number	:

Provider Business Practice Location Address
First Line	:	8103 FALLS AVE SE
Second Line	:
City	:	SNOQUALMIE
State	:	WA
Zip	:	98065-5169
Country	:	US
Telephone Number	:	425-208-5048
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	01/21/2021

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