Individual
MICHELLE M LYDSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12800 BOTHELL EVERETT HWY, EVERETT, WA 98208
(425) 316-5150
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004803
WA
363AM0700X
Medical Physician Assistant
PA10004803
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8472219
—
WA
Enumeration date
07/22/2006
Last updated
06/16/2021
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