Individual
JOHANNA MARCELA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 258-7074
Mailing address
19195 SW TEDDI ROSE CT, BEAVERTON, OR 97003-2775
(503) 258-7074
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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