Lakeshore Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKESHORE CLINIC PLLC

Practice address

10131 Main St
Bothell, WA 98011-3425

Phone

(425) 485-3955

Fax

(425) 485-1476

NPI assigned

May 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Linda R Jeppesen

Title

Ceo

Phone

(425) 485-3955

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1922052422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 646",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980410646",
            "telephone_number": "425-485-3955",
            "fax_number": "425-485-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10131 MAIN ST",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113425",
            "telephone_number": "425-485-3955",
            "fax_number": "425-485-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "JEPPESEN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-485-3955"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "G217116700",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laboratory Corporation of America
• Andra Lagergren, PT
• Joseph Chen Lai, DO
• Abbigayle Lair, MASS.MA.70157976
• Lakeshore Clinic PLLC
• Connor Nicholas Lamey
• Nicole Marcella Day Laney, M.D.
• Courtney Lang, DDS
• Mackenzie Rae Lanham
• Sara M Lantz, BCBA

• Family Medicine Physician in Bothell, WA
• Providers in Bothell, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.