Individual
SAMANTHA MAE HARDESTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
2200 BROADWAY STE C, VANCOUVER, WA 98663
(360) 326-5288
Mailing address
2200 BROADWAY STE C, VANCOUVER, WA 98663
(360) 326-5288
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00020498
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0193869
LABOR AND INDUSTRY
WA
Enumeration date
09/14/2006
Last updated
06/24/2010
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