Provider Demographics
NPI:1174921902
Name:HASTINGS, AMBER (LMP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HASTINGS
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 1:920 ALDERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9369
Mailing Address - Country:US
Mailing Address - Phone:360-488-6994
Mailing Address - Fax:
Practice Address - Street 1:205 STEWART RD
Practice Address - Street 2:SUITE 108-2
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-9607
Practice Address - Country:US
Practice Address - Phone:360-488-6994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60523284225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist