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Organization
LAKESHORE CLINIC PLLC
Active
Organization
LAKESHORE CLINIC PLLC
Active
Other names
Lakeshore Clinic Bothell
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA R JEPPESEN (CEO)
(425) 486-9131
Entity
Organization
Contact information
Practice address
10025 NE 186TH ST, BOTHELL, WA 98011-3839
(425) 486-9131
(425) 486-9490
Mailing address
PO BOX 646, BOTHELL, WA 98041-0646
(425) 485-3955
(425) 485-1476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
09/22/2006
Last updated
10/11/2012
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