Provider Demographics
NPI:1134409162
Name:TUMELSON, HOLLY BLISS (PA-C)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:BLISS
Last Name:TUMELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1565
Mailing Address - Country:US
Mailing Address - Phone:541-386-9500
Mailing Address - Fax:541-386-9540
Practice Address - Street 1:1010 10TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1565
Practice Address - Country:US
Practice Address - Phone:541-386-9500
Practice Address - Fax:541-386-9500
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA153245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR223149Medicaid
OR1807OtherHEALTH NET
OR080385000OtherBLUE CROSS BLUE SHIELD
OR080385000OtherBLUE CROSS BLUE SHIELD
OR223149Medicaid