Individual
MRS. MIMI MARIA HUGHES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(971) 206-5179
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(971) 206-5179
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA150640
OR
363AM0700X
Medical Physician Assistant
PA11905
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500619040
—
OR
Enumeration date
11/06/2009
Last updated
08/10/2020
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