Healthcare Provider Details

I. General information

NPI: 1083570030
Provider Name (Legal Business Name): LAKE CAVANAUGH WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35206 PHIPPS DR
MOUNT VERNON WA
98274-8223
US

IV. Provider business mailing address

35206 PHIPPS DR
MOUNT VERNON WA
98274-8223
US

V. Phone/Fax

Practice location:
  • Phone: 360-224-3222
  • Fax: 360-873-0306
Mailing address:
  • Phone: 360-224-3222
  • Fax: 360-873-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARAH SCHULKE
Title or Position: OWNER/FNP
Credential: NP
Phone: 360-224-3222