MEDICARE: LYNNE MARIE WIEGERT ARNP

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	363LG0600X	Gerontology Nurse Practitioner	AP60132222	WA

General Provider Information

NPI Number	:	1710218862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE MARIE WIEGERT ARNP

Provider Business Mailing Address
First Line	:	1514 NOB HILL AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-3141
Country	:	US
Telephone Number	:	206-599-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 NOB HILL AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-3141
Country	:	US
Telephone Number	:	206-920-5583
Fax Number	:

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	09/10/2011

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