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General NPI Number Information
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NPI Number | 1316836687
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Entity Type | Organization
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Legal Business Name | PROLIFIC WELL
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 520 LILLY RD NE BLDG 2
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City | OLYMPIA
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State | WA
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Zip | 98506-5255
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Country | US
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Telephone | 530-429-2096
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Fax |
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Provider Business Mailing Address
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Address Line | 9160 CANDYTUFT LANE SOUTHEAST
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City | TUMWATER
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State | WA
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Zip | 98501
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Country | US
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Telephone | 530-429-2096
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Fax |
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | DR. EVELYN LE
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Credential | ND, MPH, FAIHM
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Telephone | 530-429-2096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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