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Individual

MS. RACHAEL LEEANN WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1756
(503) 352-6151
Mailing address
3170 KETTERING BLVD, BUILDING B 3RD FLOOR, MORAINE, OH 45439-1924
(937) 991-3188
(937) 223-9811

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006457
OH
363AS0400X
Surgical Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA60890324
WASHINGTON STATE LISENCE
WA
Enumeration date
07/30/2018
Last updated
01/15/2021
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