Healthcare Provider Details

I. General information

NPI: 1659430585
Provider Name (Legal Business Name): INNATE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 1220
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

1229 MADISON ST SUITE 1220
SEATTLE WA
98104-3586
US

V. Phone/Fax

Practice location:
  • Phone: 206-264-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT920
License Number StateWA

VIII. Authorized Official

Name: DR. STEPHEN WANGEN
Title or Position: PRESIDENT
Credential: N.D.
Phone: 206-264-1111