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NPI Code Detail

MEDICARE: ANDREA LEIGH HUXTABLE PAC

MEDICARE: ANDREA LEIGH HUXTABLE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA202788OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205463312
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LEIGH HUXTABLE PAC
Provider Business Mailing Address
First Line : 847 NE 19TH AVE STE 300
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2686
Country : US
Telephone Number : 503-963-2801
Fax Number : 503-963-2825
Provider Business Practice Location Address
First Line : 2701 NW VAUGHN ST STE 150
Second Line :
City : PORTLAND
State : OR
Zip : 97210-5379
Country : US
Telephone Number : 503-229-8455
Fax Number : 503-229-7028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2020
Last Update Date : 06/20/2025

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Directions to “ ANDREA LEIGH HUXTABLE PAC” Practice Location

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