Individual
JENNIFER M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 N PROVIDENCE DR, NEWBERG, OR 97132-7485
(503) 537-5607
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD25208
OR
208M00000X
Hospitalist Physician
Primary
MD25208
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022724
—
OR
01
—
P00351753
RR MEDICARE (P-PMG
OR
Enumeration date
11/22/2005
Last updated
02/14/2022
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