Provider Demographics
NPI:1750410171
Name:WILSON, VERLINDA (RN)
Entity type:Individual
Prefix:MS
First Name:VERLINDA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5442
Mailing Address - Country:US
Mailing Address - Phone:503-645-3581
Mailing Address - Fax:503-533-0152
Practice Address - Street 1:3716 NE M L KING BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1111
Practice Address - Country:US
Practice Address - Phone:503-288-8066
Practice Address - Fax:503-288-8168
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR372600000X
OR200140935R163WM0102X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health