Provider Demographics
NPI:1528338423
Name:HOUCK, DENISE IRENE (NP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:IRENE
Last Name:HOUCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21824 NE HEARTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-6787
Mailing Address - Country:US
Mailing Address - Phone:503-660-0600
Mailing Address - Fax:
Practice Address - Street 1:1800 NE MARKET DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024
Practice Address - Country:US
Practice Address - Phone:503-660-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21545363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21545OtherNURSE PRACTITIONER LICENSE NUMBER
OR201601359NP-PPOtherNURSE PRACTITIONER LICENSE