Active NPI
Nathan Daniel Lickteig, DO
- Student in an Organized Health Care Education/Training Program
- Seattle, WA
National Provider Identifier
1649912452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1959 NE Pacific St
Seattle, WA 98195-0001 - Phone
- (206) 543-1140
- NPI assigned
- Apr 12, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Blood Banking & Transfusion Medicine Physician | 207ZB0001X | DO.OP.70077130 | WA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | NM | Primary |
Addresses
Primary practice location
1959 NE Pacific St
Seattle, WA 98195-0001
Mailing address
Msc08 4640 1 University of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-4814
Other practice location 1
Msc08 4640 1 University Of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-4814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260514004336 | WA | Order and Referring Only - Pathology | 0749759165 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781740800000",
"number": "1649912452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MSC08 4640 1 UNIVERSITY OF NEW MEXICO",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871310001",
"telephone_number": "505-272-4814",
"fax_number": "505-272-0240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981950001",
"telephone_number": "206-543-1140"
}
],
"practiceLocations": [
{
"address_1": "Msc08 4640 1 University Of New Mexico",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871310001",
"country_code": "US",
"telephone_number": "505-272-4814",
"fax_number": "505-272-0240",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LICKTEIG",
"first_name": "NATHAN",
"middle_name": "DANIEL",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-12",
"last_updated": "2026-06-18",
"certification_date": "2026-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "207ZB0001X",
"taxonomy_group": "",
"desc": "Pathology, Blood Banking & Transfusion Medicine",
"state": "WA",
"license": "DO.OP.70077130",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NM",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.