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General NPI Number Information
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NPI Number | 1922799600
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Entity Type | Organization
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Legal Business Name | HEY SISTER SPA P-LLC
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 1309 NE 134TH ST STE B
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City | VANCOUVER
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State | WA
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Zip | 98685-2704
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Country | US
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Telephone | 503-467-6589
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Fax | 571-368-5192
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Provider Business Mailing Address
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Address Line | 1410 NW KEARNEY ST APT 921
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City | PORTLAND
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State | OR
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Zip | 97209-2770
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Country | US
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Telephone | 503-467-6589
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Fax | 571-368-5192
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RENEE STORM
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Credential | APRN
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Telephone | 503-467-6589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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