Healthcare Provider Details

I. General information

NPI: 1881551695
Provider Name (Legal Business Name): NORTH LAKE RHEUMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19119 N CREEK PKWY STE 102
BOTHELL WA
98011-8023
US

IV. Provider business mailing address

19119 N CREEK PKWY STE 102
BOTHELL WA
98011-8023
US

V. Phone/Fax

Practice location:
  • Phone: 425-923-7945
  • Fax:
Mailing address:
  • Phone: 425-923-7945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLISON L RICHARDS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 425-923-7945