Healthcare Provider Details

I. General information

NPI: 1417164682
Provider Name (Legal Business Name): YOLANDA M HUGHES LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 HIDDEN ACRES LN
WINLOCK WA
98596-9300
US

IV. Provider business mailing address

168 HIDDEN ACRES LN
WINLOCK WA
98596-9300
US

V. Phone/Fax

Practice location:
  • Phone: 360-402-8592
  • Fax:
Mailing address:
  • Phone: 360-402-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017773
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: