Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor | 565162 | CA |
N | 363L00000X | Nurse Practitioner | 18232 | CA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201808928 | OR |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201808928NP-PP | OR |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP012061 | PA |
NPI | 1013045202 |
---|---|
Provider Name | Wendy J Trout |
First Address | Portland, OR 97239 |
Second Address | Portland, OR 97239-2964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 28/10/2019 |