Individual
TAMMY JO WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
Mailing address
3515 SE 3RD ST, CORVALLIS, OR 97333-9219
(503) 562-0633
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
11/07/2023
Last updated
11/07/2023
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