Individual
DODI L WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, PNP
Contact information
Practice address
9555 SW BARNES RD, SUITE 301, PORTLAND, OR 97225-6663
(503) 535-6338
(503) 535-6351
Mailing address
9555 SW BARNES RD, SUITE 301, PORTLAND, OR 97225-6663
(503) 535-6338
(503) 535-6351
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
099006377N2
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026566
—
OR
Enumeration date
01/09/2007
Last updated
07/08/2007
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