Provider Demographics
NPI:1114901972
Name:SJONG, LILLIAN JANE (ARNP MN)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:JANE
Last Name:SJONG
Suffix:
Gender:F
Credentials:ARNP MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NW 81ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4055
Mailing Address - Country:US
Mailing Address - Phone:206-744-9378
Mailing Address - Fax:206-744-9935
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-9378
Practice Address - Fax:206-744-9935
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623109Medicaid
AB28008Medicare ID - Type Unspecified
WA9623109Medicaid