Healthcare Provider Details

I. General information

NPI: 1114542420
Provider Name (Legal Business Name): NICOLE WESTPHAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 DRUM COURT
SILVERDALE WA
98315
US

IV. Provider business mailing address

2100 DRUM COURT
SILVERDALE WA
98315
US

V. Phone/Fax

Practice location:
  • Phone: 360-564-2194
  • Fax:
Mailing address:
  • Phone: 360-564-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD70074285
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116034140
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: