Healthcare Provider Details

I. General information

NPI: 1154600849
Provider Name (Legal Business Name): HANNAH LEE HULETT L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 SE DIVISION ST
PORTLAND OR
97206-1346
US

IV. Provider business mailing address

2269 SE 66TH AVE
PORTLAND OR
97215-4022
US

V. Phone/Fax

Practice location:
  • Phone: 503-772-1215
  • Fax:
Mailing address:
  • Phone: 541-400-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18316
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: