Healthcare Provider Details

I. General information

NPI: 1467876227
Provider Name (Legal Business Name): ELDA HEINTZE ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18223 102ND AVE NE STE A
BOTHELL WA
98011-3454
US

IV. Provider business mailing address

18484 47TH PL NE
LAKE FOREST PARK WA
98155-4354
US

V. Phone/Fax

Practice location:
  • Phone: 425-686-4498
  • Fax: 425-368-5245
Mailing address:
  • Phone: 425-686-4498
  • Fax: 425-368-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60414966
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60414858
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: