Healthcare Provider Details

I. General information

NPI: 1003010257
Provider Name (Legal Business Name): MICHELLE HATCH LINTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE HATCH

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24850 SE STARK SUITE 150
GRESHAM OR
97030
US

IV. Provider business mailing address

24850 SE STARK SUITE 150
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-0714
  • Fax: 503-674-2834
Mailing address:
  • Phone: 503-491-0714
  • Fax: 503-674-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01231
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: