Healthcare Provider Details

I. General information

NPI: 1609811371
Provider Name (Legal Business Name): ANNIE M HULME ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 SW MACADAM AVE SUITE 200
PORTLAND OR
97239-6102
US

IV. Provider business mailing address

5100 SW MACADAM AVE SUITE 200
PORTLAND OR
97239-6102
US

V. Phone/Fax

Practice location:
  • Phone: 597-120-2550
  • Fax: 971-202-5555
Mailing address:
  • Phone: 597-120-2550
  • Fax: 971-202-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201506291NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number078040200N5
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number078040200N5
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: