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General NPI Number Information
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NPI Number | 1568624963
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Entity Type | Individual
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Provider Name | SAMANTHA NOELLE HAYES LAC, DIPL. OM, MS.OM
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Gender | Female
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 710 E RIVER RD
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City | ANOKA
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State | MN
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Zip | 55303-2828
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Country | US
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Telephone | 651-216-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 710 E RIVER RD
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City | ANOKA
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State | MN
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Zip | 55303-2828
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Country | US
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Telephone | 651-216-3057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1436
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License Number State | MN
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