Individual
SANDRA WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4531 SE BELMONT ST, SUITE 100, PORTLAND, OR 97215-1675
(503) 215-6556
Mailing address
4531 SE BELMONT ST, SUITE 100, PORTLAND, OR 97215-1675
(503) 215-6556
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200140464RN
OR
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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