Individual
JACQUELYN LORIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1221 MADISON ST STE 600 SEATTLE, SEATTLE, WA 98104-3588
(206) 215-5900
(206) 215-2250
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60640398
WA
Other
Enumeration date
02/01/2016
Last updated
06/08/2016
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