Individual
LAURA FRENCH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210
(503) 413-8090
(503) 413-7490
Mailing address
PO BOX 4037, PORTLAND, OR 97208-4037
(503) 413-4048
(503) 413-2910
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA179418
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/15/2015
Last updated
07/20/2020
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