Provider Demographics
NPI:1265485122
Name:FOW, LYNLEY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LYNLEY
Middle Name:
Last Name:FOW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:425-899-3189
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-3181
Practice Address - Fax:425-899-3189
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1265485122Medicaid
WA8911949Medicare PIN