Individual
ELYSHA KATHARINA WIEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
9155 SW BARNES RD, SUITE 440, PORTLAND, OR 97225-6625
(503) 935-8500
(503) 935-8505
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA165833
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225459183
—
WA
05
—
500666575
—
OR
Enumeration date
12/19/2013
Last updated
03/10/2014
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