Individual
LANCE CHRISTOPHER WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 N GRAHAM ST, PORTLAND, OR 97227-1654
(503) 413-4121
Mailing address
501 N GRAHAM ST, PORTLAND, OR 97227-1654
(503) 413-4121
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN61541379
WA
Other
Enumeration date
07/10/2025
Last updated
07/10/2025
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