Healthcare Provider Details

I. General information

NPI: 1144044769
Provider Name (Legal Business Name): KATHERINE ANN HURLBUT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7759 SE 72ND AVE
PORTLAND OR
97206-7921
US

IV. Provider business mailing address

7759 SE 72ND AVE
PORTLAND OR
97206-7921
US

V. Phone/Fax

Practice location:
  • Phone: 503-788-4500
  • Fax:
Mailing address:
  • Phone: 503-788-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10028533
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: