Healthcare Provider Details

I. General information

NPI: 1629982483
Provider Name (Legal Business Name): ETHAN K HUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 CENTENNIAL DR
SILVERTON OR
97381-8744
US

IV. Provider business mailing address

1636 CENTENNIAL DR
SILVERTON OR
97381-8744
US

V. Phone/Fax

Practice location:
  • Phone: 503-779-3838
  • Fax:
Mailing address:
  • Phone: 503-779-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: