Healthcare Provider Details

I. General information

NPI: 1922799600
Provider Name (Legal Business Name): HEY SISTER SPA P-LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 NE 134TH ST STE B
VANCOUVER WA
98685-2704
US

IV. Provider business mailing address

1410 NW KEARNEY ST APT 921
PORTLAND OR
97209-2770
US

V. Phone/Fax

Practice location:
  • Phone: 503-467-6589
  • Fax: 571-368-5192
Mailing address:
  • Phone: 503-467-6589
  • Fax: 571-368-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE STORM
Title or Position: MEDICAL DIRECTOR
Credential: APRN
Phone: 503-467-6589