Basic Information
Provider Information
NPI: 1184637548
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HULSE
FirstName: JEFFREY
MiddleName: CRAIG
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 NE MULTNOMAH ST
Address2:  
City: PORTLAND
State: OR
PostalCode: 972322023
CountryCode: US
TelephoneNumber: 5038132000
FaxNumber:  
Practice Location
Address1: 500 NE MULTNOMAH ST
Address2:  
City: PORTLAND
State: OR
PostalCode: 972322023
CountryCode: US
TelephoneNumber: 5038132000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/15/2006
LastUpdateDate: 08/24/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X200460017CRNAORY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


Home