Provider Demographics
NPI:1821033465
Name:LONERGAN, KIMBERLEE ANN (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ANN
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:ANN
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:13531 JUANITA WOODINVILLE WAY NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5225
Mailing Address - Country:US
Mailing Address - Phone:425-636-2400
Mailing Address - Fax:425-636-2401
Practice Address - Street 1:13531 JUANITA WOODINVILLE WAY NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5225
Practice Address - Country:US
Practice Address - Phone:425-636-2400
Practice Address - Fax:425-636-2401
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WAAP30002217363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9618513Medicaid
WAS08395Medicare UPIN
WA9618513Medicaid