Individual
NAN NELSON WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RRT
Contact information
Practice address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(503) 331-6185
Mailing address
9617 SW 2ND AVE, PORTLAND, OR 97219-6503
(503) 799-1463
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
RC00619
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RC00619
OREGON RCP LICENSE
OR
Enumeration date
04/19/2012
Last updated
04/19/2012
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