Healthcare Provider Details

I. General information

NPI: 1649985466
Provider Name (Legal Business Name): STEMWAVE NORTHWEST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 ROOSEVELT WAY NE STE 302
SEATTLE WA
98115-2253
US

IV. Provider business mailing address

9500 ROOSEVELT WAY NE STE 302
SEATTLE WA
98115-2253
US

V. Phone/Fax

Practice location:
  • Phone: 206-409-9447
  • Fax: 904-785-7798
Mailing address:
  • Phone: 206-409-9447
  • Fax: 904-785-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CONNIE AMUNDSON
Title or Position: CO-OWNER
Credential: DC
Phone: 206-409-9447