Provider Demographics
NPI:1275520405
Name:HAYES, MICHELLE MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:HAYES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9101 BRIDGEPORT WAY SW
Mailing Address - Street 2:STE A
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2419
Mailing Address - Country:US
Mailing Address - Phone:253-565-7686
Mailing Address - Fax:253-566-0210
Practice Address - Street 1:9101 BRIDGEPORT WAY SW
Practice Address - Street 2:STE A
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2419
Practice Address - Country:US
Practice Address - Phone:253-565-7686
Practice Address - Fax:253-566-0210
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003701363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9625989Medicaid
WA9625989Medicaid