MEDICARE: LINDSEY JO FENSTERMAKER RN, BSN, CCRN

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	163W00000X	Registered Nurse	RN00166011	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	599245	OTHER	WA	PAYEE NUMBER

General Provider Information

NPI Number	:	1861815599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY JO FENSTERMAKER RN, BSN, CCRN

Provider Business Mailing Address
First Line	:	10909 246TH ST NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8108
Country	:	US
Telephone Number	:	425-870-9923
Fax Number	:

Provider Business Practice Location Address
First Line	:	10909 246TH ST NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8108
Country	:	US
Telephone Number	:	425-870-9923
Fax Number	:

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

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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