Individual
MS. DOMINIQUE RENEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP, FNP
Contact information
Practice address
205 SE SPOKANE ST STE 300, PORTLAND, OR 97202-6487
(855) 704-2004
(503) 386-3366
Mailing address
205 SE SPOKANE ST STE 300, PORTLAND, OR 97202-6487
(855) 704-2004
(503) 386-3366
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
202100794NPPP
OR
363LF0000X
Family Nurse Practitioner
AP119115
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202100794NP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP119115
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61131624
WA
Other
Enumeration date
09/30/2011
Last updated
05/01/2024
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