Provider Demographics
NPI:1851468466
Name:HACKETT, AMY SHULTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SHULTZ
Last Name:HACKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1840 E RAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:855-397-0197
Mailing Address - Fax:800-272-6512
Practice Address - Street 1:9155 SW BARNES RD STE 330
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6630
Practice Address - Country:US
Practice Address - Phone:503-772-1174
Practice Address - Fax:503-765-1445
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24517207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227005Medicaid
WA1039860Medicaid