Provider Demographics
NPI:1174561468
Name:PUHLMAN, MARK E (ANP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:PUHLMAN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:9205 SW BARNES RD
Practice Address - Street 2:2ND FLOOR, WEST PAVILLION
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6629
Practice Address - Country:US
Practice Address - Phone:503-216-2188
Practice Address - Fax:503-216-0820
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006102363LC0200X, 363LA2200X
OR201150165NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00081896OtherSTATE REGISTERED NURSE
WAAP30006102OtherSTATE ARNP LICENSE
WAMP0954594OtherDEA
WAMP0954594OtherDEA