Healthcare Provider Details

I. General information

NPI: 1497167340
Provider Name (Legal Business Name): LORI HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 SE BELMONT ST SUITE 100
PORTLAND OR
97215-1675
US

IV. Provider business mailing address

3725 SE 25TH ST
GRESHAM OR
97080-9240
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-6556
  • Fax:
Mailing address:
  • Phone: 503-674-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number090000620RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: