Get F245-051-000 Approved IME Examiner Update - lni wa

Dept. of Labor and Industries Provider Review & Education PO Box 44322 Olympia WA 98504-4322 (360) 902-6815 FAX (360) 902-4249 APPROVED IME EXAMINER UPDATE Please type or print CONTACT INFORMATION Conduct examinations for: Examiner name (Last, First, MI) Examiner mailing address City State Fund Self Insured Crime Victims Compensation National Provider Number (optional) Phone number State ZIP + 4 Do you have...
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