Provider Demographics
NPI:1891461588
Name:WILSON, ADRIENNE ERIN (CLD, CPD, CCE, NCS)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:ERIN
Last Name:WILSON
Suffix:
Gender:F
Credentials:CLD, CPD, CCE, NCS
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:ERIN
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69187 LARIAT
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-9687
Mailing Address - Country:US
Mailing Address - Phone:208-462-0721
Mailing Address - Fax:
Practice Address - Street 1:1655 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7845
Practice Address - Country:US
Practice Address - Phone:503-877-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105188374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty