Individual
MOLLY ANN WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1226
(503) 494-4781
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3098
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA214527
OR
363A00000X
Physician Assistant
PA61423634
WA
363AM0700X
Medical Physician Assistant
Primary
PA214527
OR
Other
Enumeration date
03/22/2023
Last updated
05/08/2024
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