Basic Information
| Provider Information | |||||||||
| NPI: | 1447437272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | LYNNE | ||||||||
| MiddleName: | CLAIRE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOERNER | ||||||||
| OtherFirstName: | LYNNE | ||||||||
| OtherMiddleName: | CLAIRE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ARNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1110 112TH AVE NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980044509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257493324 | ||||||||
| FaxNumber: | 4256888110 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 112TH AVE NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980044509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257493324 | ||||||||
| FaxNumber: | 4256888110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2008 | ||||||||
| LastUpdateDate: | 02/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP1700X | AP30008020 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Perinatal | 363LA2200X | AP30008020 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | AP30008020 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | AP30008020 | 01 | WA | WA ARNP LICENSE | OTHER |