Individual
JILL KEITGES WELLNITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5330 NE GLISAN ST, SUITE 200, PORTLAND, OR 97213-3069
(503) 215-9080
(503) 215-9099
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01112
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500600088
—
OR
Enumeration date
07/24/2006
Last updated
07/01/2021
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