Individual
JAMIE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
18040 SW LOWER BOONES FERRY RD, STE 100, PORTLAND, OR 97224-7258
(503) 216-0700
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200842437RN
OR
363LF0000X
Family Nurse Practitioner
Primary
20150712NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500693425
—
OR
Enumeration date
09/18/2015
Last updated
03/25/2021
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