Provider Demographics
NPI:1245288869
Name:VIGESAA, LYNNE B (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:B
Last Name:VIGESAA
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:1260 116TH AVENUE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-455-3376
Mailing Address - Fax:425-455-2766
Practice Address - Street 1:1260 116TH AVENUE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-455-3376
Practice Address - Fax:425-455-2766
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30000002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9600941Medicaid
WA9600941Medicaid
WAAB38550Medicare ID - Type Unspecified