Individual
HAYLEY M CUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
5050 NE HOYT ST, SUITE 511, PORTLAND, OR 97213-2991
(503) 962-1020
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA179550
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500715848
—
OR
Enumeration date
09/08/2016
Last updated
02/19/2021
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