Individual
KRISTINA M WAKEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8276
(503) 494-2025
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(866) 617-6855
(503) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
MD214098
OR
207ZP0101X
Anatomic Pathology Physician
TP207
KY
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
68931
WI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/03/2014
Last updated
02/08/2023
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