Individual
ROSE WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
16770 SW EDY RD, SHERWOOD, OR 97140-9678
(503) 216-9600
(503) 216-9650
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
084058952N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084504
—
OR
Enumeration date
10/12/2006
Last updated
07/01/2021
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