Individual
BRENDAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9345 SW SKOKOMISH LN, TUALATIN, OR 97062-7316
(971) 979-2149
Mailing address
9345 SW SKOKOMISH LN, TUALATIN, OR 97062-7316
(971) 979-2149
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
202000644RN
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
228251
AK
Other
Enumeration date
09/12/2024
Last updated
09/12/2024
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