1497786735 NPI number — MS. REBECCA THERESA HILL CPNP,PMHNP

Table of content: MS. REBECCA THERESA HILL CPNP,PMHNP (NPI 1497786735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497786735 NPI number — MS. REBECCA THERESA HILL CPNP,PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
REBECCA
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP,PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497786735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5415 SE MILWAUKIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97202-4940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-233-5405
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21210 NW MAUZEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97124-9327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-439-9531
Provider Business Practice Location Address Fax Number:
503-531-3841
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  077038688N2 PNP PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: AP30006393 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 201150141NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000486NP . This is a "OMAP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 164936 STATE OR . This is a "GROUP MEDICAID" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 0000WDCH STATE OR . This is a "GROUP MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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