Provider Demographics
NPI:1164727764
Name:LICHENSTEIN-HILL, SOPHIA MAY (ARNP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MAY
Last Name:LICHENSTEIN-HILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S BOND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-4373
Mailing Address - Fax:503-418-4189
Practice Address - Street 1:3303 S BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-4373
Practice Address - Fax:503-418-4189
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60162501363L00000X
OR201503416NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500690191Medicaid
WAP00991123OtherRAILROAD MEDICARE
WA0277788OtherDEPT OF LABOR & INDUSTRIES
WA1164727764OtherMONTANA DSHS
WA1164727764Medicaid
WA8912550Medicare PIN
WA8902286Medicare PIN
OR182075Medicare PIN
WA8899953Medicare PIN