Individual
STACEY L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3460
(503) 626-5515
Mailing address
8646 NW SKYLINE BLVD, PORTLAND, OR 97231-2618
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
OR 200050017NP
OR
Other
Enumeration date
03/15/2007
Last updated
04/29/2008
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