Individual
NIEMA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1216 NW 21ST AVE, PORTLAND, OR 97209-1609
(503) 662-2490
Mailing address
4110 SE HAWTHORNE BLVD # 905, PORTLAND, OR 97214-5246
(503) 662-2490
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24018
OR
Other
Enumeration date
03/21/2018
Last updated
03/21/2018
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