Individual provider · Type 1 NPI
Stacey L. Wilson, CNM
Obstetrics & Gynecology Nurse Practitioner · Beaverton, OR
NPI number
1629102272
Active
Practice location
4855 SW Western Ave
Beaverton, OR 97005-3460
Mailing address
8646 NW Skyline Blvd
Portland, OR 97231-2618
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Obstetrics & Gynecology Nurse Practitioner Primary | 363LX0001X | OR 200050017NP (OR) |
Obstetrics & Gynecology Nurse Practitioner: Definition to come...
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About NPI 1629102272
Stacey L. Wilson, CNM's National Provider Identifier is 1629102272, issued on Mar 15, 2007. The primary taxonomy on file is Obstetrics & Gynecology Nurse Practitioner (363LX0001X), and the practice location is in Beaverton, OR. The record was last updated on Apr 29, 2008.