Provider Demographics
NPI:1609811371
Name:HULME, ANNIE M (ANP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:HULME
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 SW MACADAM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6102
Mailing Address - Country:US
Mailing Address - Phone:597-120-2550
Mailing Address - Fax:971-202-5555
Practice Address - Street 1:5100 SW MACADAM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6102
Practice Address - Country:US
Practice Address - Phone:597-120-2550
Practice Address - Fax:971-202-5555
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201506291NP363LA2200X
OR078040200N5176B00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR263707Medicaid
OR112479Medicare ID - Type Unspecified
ORR81223Medicare UPIN