Individual
KELLY WULF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2565 NW LOVEJOY ST, SUITE 100, PORTLAND, OR 97210-2996
(503) 279-9700
(503) 279-8114
Mailing address
8614 E MILL PLAIN BLVD, STE 400, VANCOUVER, WA 98664-2092
(360) 254-5267
(360) 254-6089
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PA164512
OR
363A00000X
Physician Assistant
PA164512
OR
363AM0700X
Medical Physician Assistant
Primary
PA164512
OR
Other
Enumeration date
02/13/2012
Last updated
11/08/2018
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