Individual
MR. NATHAN WADE FENNEWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD # OP31, ORTHOPEDICS & REHABILITATION DEPARTMENT, PORTLAND, OR 97239-3011
(636) 688-9260
Mailing address
3181 SW SAM JACKSON PARK RD # OP31, ORTHOPEDICS & REHABILITATION DEPARTMENT, PORTLAND, OR 97239-3011
(636) 688-9260
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA176237
OR
Other
Enumeration date
03/01/2016
Last updated
03/01/2016
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