MS. DOMINIQUE RENEE WILSON DNP PMHNP FNP NPI 1295019909

NPI Information

NPI: 1295019909
Provider Name: MS. DOMINIQUE RENEE WILSON, DNP, PMHNP, FNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
205 SE SPOKANE ST STE 300
PORTLAND, OR
ZIP 97202
Phone: (855) 704-2004
Get Directions

MS. Dominique Renee Wilson, DNP, PMHNP, FNP is a psychiatric/mental health nurse practitioner in Portland, OR with 6 years of experience. MS. Dominique Renee Wilson, DNP, PMHNP, FNP NPI is 1295019909. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

205 SE SPOKANE ST STE 300
PORTLAND, OR
ZIP 97202-487
Phone: (855) 704-2004
Fax: (503) 386-3366

The NPI 1295019909 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/30/2011 and was last updated on 7/21/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	202100794NPPP	OREGON	No
2	363LF0000X	Nurse Practitioner	Family	AP119115	TEXAS	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	AP61131624	WASHINGTON	No
4	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	AP119115	TEXAS	No
5	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	202100794NP	OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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