Individual
SOLANGE MARIE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-4200
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8451
(503) 494-2759
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD25295
OR
207VM0101X
Maternal & Fetal Medicine Physician
MD00047990
WA
207VM0101X
Maternal & Fetal Medicine Physician
Primary
MD25295
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750399218
—
WA
05
—
233466
—
OR
Enumeration date
08/03/2006
Last updated
02/04/2022
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