Healthcare Provider Details

I. General information

NPI: 1003584053
Provider Name (Legal Business Name): MAGDALYNN HAYS CN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 FRANKLIN ST STE 103
VANCOUVER WA
98660-2860
US

IV. Provider business mailing address

11211 NE 20TH ST APT 83
VANCOUVER WA
98684-5553
US

V. Phone/Fax

Practice location:
  • Phone: 360-787-3615
  • Fax: 833-324-3373
Mailing address:
  • Phone: 360-903-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU61196416
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: