MEDICARE: INNATE HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	NT920	WA

General Provider Information

NPI Number	:	1659430585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNATE HEALTH PLLC

Provider Business Mailing Address
First Line	:	1229 MADISON ST
Second Line	:	SUITE 1220
City	:	SEATTLE
State	:	WA
Zip	:	98104-3586
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 MADISON ST
Second Line	:	SUITE 1220
City	:	SEATTLE
State	:	WA
Zip	:	98104-3586
Country	:	US
Telephone Number	:	206-264-1111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN WANGEN
Credential	:	N.D.
Telephone Number	:	206-264-1111

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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