Individual
EZRA ZAYNE WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18766 SE STARK ST, PORTLAND, OR 97233-5330
(503) 243-2236
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/22/2022
Last updated
04/22/2022
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