Individual provider · Type 1 NPI

Ryan Wallenberg, MD

Student in an Organized Health Care Education/Training Program · Portland, OR

NPI number 1114283561 Active

Practice location

3181 SW Sam Jackson Park Road
Portland, OR 97239

Call (503) 494-8211 Map

Mailing address

1623 S Taverner Dr
Ridgefield, WA 98642

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1114283561

Ryan Wallenberg, MD's National Provider Identifier is 1114283561, issued on Apr 10, 2012. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Portland, OR. The record was last updated on Apr 10, 2012.