Provider Demographics
NPI:1427321058
Name:NAMOLIK, NATHAN KYLE (LAC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:KYLE
Last Name:NAMOLIK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5853 NE 181ST ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4510
Mailing Address - Country:US
Mailing Address - Phone:425-381-3697
Mailing Address - Fax:
Practice Address - Street 1:5853 NE 181ST ST
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4510
Practice Address - Country:US
Practice Address - Phone:425-381-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60252801171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist