Healthcare Provider Details

I. General information

NPI: 1386942076
Provider Name (Legal Business Name): MICHELLE HILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8944 237TH PL NE
REDMOND WA
98053-1981
US

IV. Provider business mailing address

8944 237TH PL NE
REDMOND WA
98053-1981
US

V. Phone/Fax

Practice location:
  • Phone: 425-452-8918
  • Fax:
Mailing address:
  • Phone: 425-452-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT1230
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: