Individual
BRIANNA WING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP, RN
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2335343
MA
207Q00000X
Family Medicine Physician
202112150NP-PP
OR
363LW0102X
Women's Health Nurse Practitioner
10171-33
WI
363LW0102X
Women's Health Nurse Practitioner
Primary
202112150NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10171-33
WISCONSIN BOARD OF NURSING
WI
01
—
202112150NP-PP
OR STATE BOARD OF NURSING
OR
Enumeration date
12/18/2019
Last updated
10/16/2024
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