Healthcare Provider Details

I. General information

NPI: 1174440952
Provider Name (Legal Business Name): WAYLON M WADDELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 18TH AVE S
SEATTLE WA
98144-4317
US

IV. Provider business mailing address

1930 4TH ST
BREMERTON WA
98337-1004
US

V. Phone/Fax

Practice location:
  • Phone: 206-408-5321
  • Fax:
Mailing address:
  • Phone: 206-319-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: