MEDICARE: ELIZABETH MARIE HUGHES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA174714	OR

General Provider Information

NPI Number	:	1629479282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARIE HUGHES PA-C

Provider Business Mailing Address
First Line	:	1909 MOUNTAIN VIEW LN
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2893
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 MOUNTAIN VIEW LN
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2893
Country	:	US
Telephone Number	:	503-359-4773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	10/02/2015

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