Individual
DR. JENNY LUPOVICI WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(503) 494-9113
Mailing address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(503) 804-6824
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
MD162292
OR
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
MD441944
PA
Other
Enumeration date
05/26/2008
Last updated
05/21/2013
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