Individual
CHANIDA PUTWANPHEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 7TH AVE SW, ALBANY, OR 97321-1925
(541) 812-5600
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1061486
TX
363L00000X
Nurse Practitioner
Primary
202215285NP-PP
OR
363L00000X
Nurse Practitioner
61302785
WA
Other
Enumeration date
07/30/2022
Last updated
06/20/2023
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