Individual
MS. CHRISTINE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
3896 BEVERLY AVE. SE, BLDG. J, STE. 40, SALEM, OR 97305-1374
(503) 588-0076
(503) 588-0531
Mailing address
402 N 4TH STREET, SUITE 202, YAKIMA, WA 98901-0190
(509) 248-3782
(503) 588-0531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01463
OR
363A00000X
Physician Assistant
PA15054
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA01463
MEDICAL LICENSE OREGON
OR
Enumeration date
10/04/2006
Last updated
11/29/2011
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