Individual
TAMMY LEIGH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6464 SW BORLAND RD, SUITE C-4, TUALATIN, OR 97062-8876
(503) 885-7770
(503) 961-8454
Mailing address
6464 SW BORLAND RD, SUITE C-4, TUALATIN, OR 97062-8876
(503) 885-7770
(503) 961-8454
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA156635
OR
Other
Enumeration date
11/13/2011
Last updated
11/13/2011
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