Individual
ELIZABETH WADNIZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
511 SW 10TH AVE STE 1108, PORTLAND, OR 97205-2713
(503) 224-6800
Mailing address
511 SW 10TH AVE STE 1108, PORTLAND, OR 97205-2713
(503) 224-6800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18882
OR
Other
Enumeration date
12/28/2015
Last updated
12/28/2015
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