Provider Demographics
NPI:1831425842
Name:WHEELER, SAGE CLINTON
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:CLINTON
Last Name:WHEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 NE 90TH ST
Mailing Address - Street 2:B503
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8230
Mailing Address - Country:US
Mailing Address - Phone:425-681-9310
Mailing Address - Fax:
Practice Address - Street 1:15655 NE 85TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3563
Practice Address - Country:US
Practice Address - Phone:425-881-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60113319175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath