Organization
LAKESHORE CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA R JEPPESEN (CEO)
(425) 485-3955
Entity
Organization
Contact information
Practice address
10131 MAIN ST, BOTHELL, WA 98011-3425
(425) 485-3955
(425) 485-1476
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
—
—
207R00000X
Internal Medicine Physician
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G217116700
PTAN
WA
Enumeration date
05/19/2006
Last updated
02/18/2014
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