Basic Information
| Provider Information | |||||||||
| NPI: | 1700187788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIRKS | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 839 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982060839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252123993 | ||||||||
| FaxNumber: | 4252593073 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 LOMBARD AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252123993 | ||||||||
| FaxNumber: | 4252593073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2010 | ||||||||
| LastUpdateDate: | 11/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.