Provider Demographics
NPI:1881856680
Name:TAN, LYNNE ABIGAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:ABIGAIL
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 QUEEN ANNE AVE N
Mailing Address - Street 2:APT 312
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3273
Mailing Address - Country:US
Mailing Address - Phone:407-765-3165
Mailing Address - Fax:
Practice Address - Street 1:550 16TH AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5699
Practice Address - Country:US
Practice Address - Phone:206-320-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML 60021929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine