# LAKESHORE CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeshore Clinic Bothell
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841399870
- **Authorized official:** LINDA R JEPPESEN (CEO)
- **Authorized official phone:** (425) 486-9131

## Contact information

- **Practice address:** 10025 NE 186TH ST, BOTHELL, WA 98011-3839
- **Practice address phone:** (425) 486-9131
- **Practice address fax:** (425) 486-9490
- **Mailing address:** PO BOX 646, BOTHELL, WA 98041-0646
- **Mailing address phone:** (425) 485-3955
- **Mailing address fax:** (425) 485-1476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 10/11/2012