Individual
MRS. CAROL ANN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
402 SE 3RD AVE, ESTACADA, OR 97023-8563
(503) 630-6787
(503) 630-6787
Mailing address
PO BOX 514, ESTACADA, OR 97023-0514
(503) 630-6787
(503) 630-6787
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
000032351RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
098011
—
OR
Enumeration date
11/27/2006
Last updated
01/07/2010
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