Healthcare Provider Details

I. General information

NPI: 1831425842
Provider Name (Legal Business Name): SAGE CLINTON WHEELER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 NE 85TH ST SUITE 2
REDMOND WA
98052-3563
US

IV. Provider business mailing address

2021 NE 90TH ST B503
SEATTLE WA
98115-8230
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-3100
  • Fax:
Mailing address:
  • Phone: 425-681-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60113319
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: