Healthcare Provider Details

I. General information

NPI: 1316836687
Provider Name (Legal Business Name): PROLIFIC WELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 LILLY RD NE BLDG 2
OLYMPIA WA
98506-5255
US

IV. Provider business mailing address

9160 CANDYTUFT LANE SOUTHEAST
TUMWATER WA
98501
US

V. Phone/Fax

Practice location:
  • Phone: 530-429-2096
  • Fax:
Mailing address:
  • Phone: 530-429-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EVELYN LE
Title or Position: CLINIC OWNER
Credential: ND, MPH, FAIHM
Phone: 530-429-2096