=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104496132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW DZIKOWSKI ND, L.AC, ARNP, SUDP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2021
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5005 200TH ST SW STE B
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-6679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-224-5302
-----------------------------------------------------
Fax | 425-678-0434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5005 200TH ST SW STE B
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-6682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-224-5302
-----------------------------------------------------
Fax | 425-678-0434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP61571216
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN60621233
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | NT61195829
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CP70110844
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC61209772
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------