Healthcare Provider Details

I. General information

NPI: 1336672849
Provider Name (Legal Business Name): LUKE J VANDEKROL ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

IV. Provider business mailing address

233 E MAIN ST STE 401
BOZEMAN MT
59715-5045
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-4981
  • Fax: 206-860-6726
Mailing address:
  • Phone: 406-219-7835
  • Fax: 406-794-0352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61333792
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60970766
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: