Individual
ANGELA WYNIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5330 NE GLISAN ST, SUITE 100, PORTLAND, OR 97213-3069
(503) 215-9700
(503) 215-9701
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA160417
OR
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/11/2012
Last updated
12/29/2020
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