Healthcare Provider Details

I. General information

NPI: 1063825610
Provider Name (Legal Business Name): AMBER AMARIS HULL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 EXCHANGE ST
ASTORIA OR
97103
US

IV. Provider business mailing address

2111 EXCHANGE ST
ASTORIA OR
97103-3329
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-7337
  • Fax: 503-325-3706
Mailing address:
  • Phone: 503-325-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO183087
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: