Individual
BAREDU BONSO WOTCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3099 RIVER RD S, SALEM, OR 97302-9754
(503) 581-1567
(503) 581-1567
Mailing address
3099 RIVER RD S, SALEM, OR 97302-9754
(503) 581-1567
(503) 581-1567
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA218535
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
PA218535
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/04/2021
Last updated
04/21/2026
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