Provider Demographics
NPI:1568624963
Name:HAYES, SAMANTHA NOELLE (LAC, DIPL OM, MSOM)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NOELLE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LAC, DIPL OM, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2828
Mailing Address - Country:US
Mailing Address - Phone:651-216-3057
Mailing Address - Fax:
Practice Address - Street 1:710 E RIVER RD
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2828
Practice Address - Country:US
Practice Address - Phone:651-216-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1436171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist