Individual
KELLY KATHLEEN WOLFE FROMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-PP
Contact information
Practice address
5100 SW MACADAM AVE, #200, PORTLAND, OR 97239-6102
(971) 202-5500
Mailing address
5100 S MACADAM AVE STE 200, PORTLAND, OR 97239-3827
(971) 202-5500
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
201501921NP-PP
OR
363LG0600X
Gerontology Nurse Practitioner
201501921NP-PP
OR
363LP2300X
Primary Care Nurse Practitioner
Primary
201501921NP-PP
OR
Other
Enumeration date
05/14/2015
Last updated
12/07/2021
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