Individual
WENDY OSORIO DOMREIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-4314
Mailing address
11025 SW ESQUILINE CIRCUS, PORTLAND, OR 97219-7876
(503) 418-5892
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
098006824RN
OR
363LP0200X
Pediatric Nurse Practitioner
Primary
200350089NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275499
—
OR
Enumeration date
07/31/2006
Last updated
12/20/2011
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