Provider Demographics
NPI:1588898332
Name:HILLSTROM, MICHELLE (LMP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:HILLSTROM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 A ST. SE
Mailing Address - Street 2:B101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-0060
Mailing Address - Country:US
Mailing Address - Phone:253-939-8144
Mailing Address - Fax:253-939-2289
Practice Address - Street 1:4017 A ST SE
Practice Address - Street 2:B101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8607
Practice Address - Country:US
Practice Address - Phone:253-939-8144
Practice Address - Fax:253-939-2289
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist