Healthcare Provider Details

I. General information

NPI: 1558842773
Provider Name (Legal Business Name): NICHOLAS MICHAEL MCHUGH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 SE SUNNYSIDE RD STE 100
CLACKAMAS OR
97015-5755
US

IV. Provider business mailing address

10121 SE SUNNYSIDE RD
CLACKAMAS OR
97015-5745
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-1769
  • Fax: 503-659-7522
Mailing address:
  • Phone: 503-659-1769
  • Fax: 503-659-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA217701
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: