Individual
WONDMIMU EDAO CHAKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3708 SE 144TH AVENUE, PORTLAND, OR 97236
(971) 255-0029
(503) 762-9080
Mailing address
3708 SE 144TH AVE, PORTLAND, OR 97236-2731
(971) 255-0029
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200241818RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200241818RN
OBN
OR
Enumeration date
10/17/2017
Last updated
10/17/2017
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