Healthcare Provider Details

I. General information

NPI: 1205099884
Provider Name (Legal Business Name): DANIELLE HIATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12946 SE KENT KANGLEY RD
KENT WA
98030-7940
US

IV. Provider business mailing address

12946 SE KENT KANGLEY RD
KENT WA
98030-7940
US

V. Phone/Fax

Practice location:
  • Phone: 253-631-6874
  • Fax: 253-631-7131
Mailing address:
  • Phone: 253-631-6874
  • Fax: 253-631-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00020937
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: