Healthcare Provider Details

I. General information

NPI: 1689777096
Provider Name (Legal Business Name): DONNA MARIE LEWIS HELLUMS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 SW HAMPTON ST KAISER PERMANENTE
TIGARD OR
97223
US

IV. Provider business mailing address

1609 NE 137TH AVE
PORTLAND OR
97230
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-9274
  • Fax: 503-624-9210
Mailing address:
  • Phone: 503-257-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH1993
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00002850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: