Provider Demographics
NPI:1528508751
Name:HONEGGER, EVANGELYNN FAITH (ND, LAC)
Entity type:Individual
Prefix:
First Name:EVANGELYNN
Middle Name:FAITH
Last Name:HONEGGER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12006 98TH AVE NE STE 103
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4218
Mailing Address - Country:US
Mailing Address - Phone:425-828-4000
Mailing Address - Fax:
Practice Address - Street 1:12006 98TH AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4218
Practice Address - Country:US
Practice Address - Phone:425-820-1643
Practice Address - Fax:425-820-1645
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60809552261QP2300X
WAAC60736418171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No171100000XOther Service ProvidersAcupuncturist