Healthcare Provider Details

I. General information

NPI: 1083400311
Provider Name (Legal Business Name): CASCADE HEADACHE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 7TH AVE. SE SUITE 200, PMB 2872
LACEY WA
98503
US

IV. Provider business mailing address

4405 7TH AVE. SE SUITE 200, PMB 2872
LACEY WA
98503
US

V. Phone/Fax

Practice location:
  • Phone: 253-220-4635
  • Fax: 253-237-9326
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL A URKOV
Title or Position: OWNER & PROVIDER
Credential: DNP, ARNP, FNP-C
Phone: 253-220-4635