Healthcare Provider Details

I. General information

NPI: 1356829642
Provider Name (Legal Business Name): ANNIE HOAG RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 DEADMOND FERRY RD
SPRINGFIELD OR
97477-9406
US

IV. Provider business mailing address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-7750
  • Fax: 541-338-1079
Mailing address:
  • Phone: 541-513-5267
  • Fax: 541-543-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-15885
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: