MEDICARE: PATTY JO LYMAN PA-C

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	363AM0700X	Medical Physician Assistant	PA10000594	WA

General Provider Information

NPI Number	:	1407815129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTY JO LYMAN PA-C

Provider Business Mailing Address
First Line	:	1660 S COLUMBIAN WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 S COLUMBIAN WAY
Second Line	:	SCI-128
City	:	SEATTLE
State	:	WA
Zip	:	98108-1532
Country	:	US
Telephone Number	:	206-764-2552
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/11/2007

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