Provider Demographics
NPI:1053865006
Name:LIFESPAN BIOSCIENCES
Entity Type:Organization
Organization Name:LIFESPAN BIOSCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SCIENTIFIC OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-464-1554
Mailing Address - Street 1:2401 4TH AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-3419
Mailing Address - Country:US
Mailing Address - Phone:206-464-1554
Mailing Address - Fax:206-464-1723
Practice Address - Street 1:2401 4TH AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-3419
Practice Address - Country:US
Practice Address - Phone:206-464-1554
Practice Address - Fax:206-464-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty