Provider Demographics
NPI:1669715611
Name:HULETT, BLAIR LITTLETON (PA-C)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:LITTLETON
Last Name:HULETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:LOUISE
Other - Last Name:LITTLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3838 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2224
Mailing Address - Country:US
Mailing Address - Phone:503-992-0288
Mailing Address - Fax:
Practice Address - Street 1:3838 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2224
Practice Address - Country:US
Practice Address - Phone:503-992-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA160875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical