Individual
LILI L CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
UWMC-ROOSEVELT, 4245 ROOSEVELT WAY NE, SEATTLE, WA 98105-4770
(206) 598-4055
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00024131
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003
INTERNAL ID-MOTOR VEHICLE ID
—
01
—
0245242
L&I
WA
05
—
1376629162
—
WA
Enumeration date
10/27/2006
Last updated
06/20/2013
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