Provider Demographics
NPI:1467693366
Name:WILSON, DAVONNA (DNP, ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:DAVONNA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DNP, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SE SPOKANE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6487
Mailing Address - Country:US
Mailing Address - Phone:888-508-4068
Mailing Address - Fax:503-506-0602
Practice Address - Street 1:205 SE SPOKANE ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6487
Practice Address - Country:US
Practice Address - Phone:888-508-4068
Practice Address - Fax:503-506-0602
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID64659363LP0808X, 363LP0808X
AZ240847363LP0808X, 363LP0808X
WAAP61066680363LP0808X
OR202010502NPPP363LP0808X
WARN61066680363LP0808X
DCRN1059458363LP0808X
OR202010502NP363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health