Provider Demographics
NPI:1174900237
Name:DE OLIVEIRA, HUGO (ARNP)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:DE OLIVEIRA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:MOSSYROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98564-0326
Mailing Address - Country:US
Mailing Address - Phone:360-983-3589
Mailing Address - Fax:360-925-3180
Practice Address - Street 1:424 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:MOSSYROCK
Practice Address - State:WA
Practice Address - Zip Code:98564-9001
Practice Address - Country:US
Practice Address - Phone:360-983-3589
Practice Address - Fax:360-925-3180
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60543520363L00000X, 363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG9012562OtherMEDICARE
WA2045063Medicaid