Healthcare Provider Details

I. General information

NPI: 1427136977
Provider Name (Legal Business Name): HERITAGE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 HARRISON AVE NW STE 101
OLYMPIA WA
98502-5084
US

IV. Provider business mailing address

4001 HARRISON AVE NW
OLYMPIA WA
98502-5084
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-2362
  • Fax: 360-350-1445
Mailing address:
  • Phone: 360-704-2362
  • Fax: 360-350-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDEEP KAUR MANN
Title or Position: OWNER
Credential: DNP
Phone: 253-394-6574