Provider Demographics
NPI:1831420017
Name:WILSON, TAMARA JEAN (WHNP-BC, CNM)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:JEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:WHNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-0491
Mailing Address - Country:US
Mailing Address - Phone:503-504-4635
Mailing Address - Fax:
Practice Address - Street 1:890 OAK ST SE STE 5050
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3905
Practice Address - Country:US
Practice Address - Phone:503-814-4480
Practice Address - Fax:503-814-4482
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050013NP363LW0102X
OR201050012NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health