Individual
DR. AUDRA LUZ KATHLEENA WISHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
930 SW ABBEY ST, NEWPORT, OR 97365-4820
(541) 265-2244
(541) 574-1838
Mailing address
PO BOX 2847, CORVALLIS, OR 97339-2847
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD182496
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500729523
—
OR
Enumeration date
07/23/2014
Last updated
11/02/2020
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