Provider Demographics
NPI:1356829642
Name:HOAG, ANNIE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:HOAG
Suffix:
Gender:
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 S MACADAM AVE STE N
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6106
Mailing Address - Country:US
Mailing Address - Phone:541-513-5267
Mailing Address - Fax:541-543-2245
Practice Address - Street 1:353 DEADMOND FERRY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-9406
Practice Address - Country:US
Practice Address - Phone:541-222-7750
Practice Address - Fax:541-338-1079
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-15885163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty