Individual
MICAH JAMES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1050 SW 3RD AVE, STE 3200, ONTARIO, OR 97914-2193
(541) 881-7370
(541) 881-7379
Mailing address
1050 SW 3RD AVE, STE 3200, ONTARIO, OR 97914-2193
(541) 881-7370
(541) 881-7379
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201150063NP
OR
Other
Enumeration date
07/08/2011
Last updated
07/08/2011
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