Provider Demographics
NPI:1023306149
Name:POLLY LYSEN-HALPERN
Entity type:Organization
Organization Name:POLLY LYSEN-HALPERN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:POLLYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYSEN-HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-414-9992
Mailing Address - Street 1:3216 NE 45TH PL
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4093
Mailing Address - Country:US
Mailing Address - Phone:206-414-9992
Mailing Address - Fax:206-452-3010
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:SUITE 212
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:206-414-9992
Practice Address - Fax:206-452-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003688261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center