Healthcare Provider Details

I. General information

NPI: 1154290401
Provider Name (Legal Business Name): TREVIS JOSHUA HUTSELL RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 NW 6TH AVE FL 3
PORTLAND OR
97209-3991
US

IV. Provider business mailing address

619 NW 6TH AVE FL 3
PORTLAND OR
97209-3991
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5020
  • Fax: 503-988-5022
Mailing address:
  • Phone: 503-988-5020
  • Fax: 503-988-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201140395RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: