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General NPI Number Information
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NPI Number | 1083400311
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Entity Type | Organization
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Legal Business Name | CASCADE HEADACHE, LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 4505 PACIFIC HWY E STE C2
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City | FIFE
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State | WA
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Zip | 98424-2638
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Country | US
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Telephone | 253-220-4635
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 PACIFIC HWY E STE C2
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City | FIFE
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State | WA
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Zip | 98424-2638
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL A URKOV
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Credential | DNP, FNP-C
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Telephone | 253-220-4635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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