Provider Demographics
NPI:1588950612
Name:HILLYER, SAMANTHA (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:HILLYER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND, LAC
Mailing Address - Street 1:PO BOX 53223
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-3223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12356 NORTHUP WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1956
Practice Address - Country:US
Practice Address - Phone:425-556-0484
Practice Address - Fax:425-529-9651
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60232240171100000X
WANT60257521175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist