Healthcare Provider Details

I. General information

NPI: 1962912089
Provider Name (Legal Business Name): LANCE WESTENDARP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 NE 24TH ST STE A
BELLEVUE WA
98008-2460
US

IV. Provider business mailing address

15650 NE 24TH ST STE A
BELLEVUE WA
98008-2460
US

V. Phone/Fax

Practice location:
  • Phone: 425-505-2745
  • Fax:
Mailing address:
  • Phone: 425-505-2745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: