Individual
DR. WILDER AWEN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
DSOM
Contact information
Practice address
3115 NE SANDY BLVD STE 231, PORTLAND, OR 97232-2779
(503) 701-8766
Mailing address
3115 NE SANDY BLVD STE 231, PORTLAND, OR 97232-2779
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC203008
OR
Other
Enumeration date
12/17/2020
Last updated
08/21/2024
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