WESTERN WASHINGTON MEDICAL GROUP INC PS NPI 1003809229

NPI Information

WESTERN WASHINGTON MEDICAL GROUP, INC PS is a primary care clinic center in Lynnwood, WA. WESTERN WASHINGTON MEDICAL GROUP, INC PS NPI is 1003809229. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Serene Clinic.

The provider's business location address is:

3501 SHELBY RD
SUITE B
LYNNWOOD, WA
ZIP 98087-599
Phone: (425) 742-9119

The provider's authorized official is Corey Don Friesen .
The authorized official title is Ceo Administrator and has the following contact phone number (425) 742-9119.

The CLIA number assigned to this NPI record is 50D0630514 - other - clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/23/2005 and was last updated on 2/23/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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