Provider Demographics
NPI:1558701532
Name:BURKE-LAZARUS, JESSICA (CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BURKE-LAZARUS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:9245 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5569
Practice Address - Country:US
Practice Address - Phone:206-722-8444
Practice Address - Fax:206-721-6310
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60170725163W00000X
WAAP60390199367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse