Provider Demographics
NPI:1023877636
Name:DAVAULT, HILLARY DIANE
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:DIANE
Last Name:DAVAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 NE HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6116
Mailing Address - Country:US
Mailing Address - Phone:503-709-0008
Mailing Address - Fax:
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 111
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7357
Practice Address - Country:US
Practice Address - Phone:503-709-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201604360RN163WP0200X
OR10030013363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics