Healthcare Provider Details

I. General information

NPI: 1821500117
Provider Name (Legal Business Name): KIMBERLY MARIE HUTCHINSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 W BURNSIDE ST
PORTLAND OR
97209-3514
US

IV. Provider business mailing address

232 NW 6TH AVENUE ATTN: BBIS CREDENTIALING
PORTLAND OR
97209
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-4533
  • Fax: 503-228-4618
Mailing address:
  • Phone: 503-501-5641
  • Fax: 503-241-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200040048RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: