Healthcare Provider Details

I. General information

NPI: 1427692623
Provider Name (Legal Business Name): ROXANNE FRANKLIN WILSON BA, QMHA, PSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NE HIGHWAY 99W STE K
MCMINNVILLE OR
97128-2757
US

IV. Provider business mailing address

650 NE 2ND ST UNIT 133
MCMINNVILLE OR
97128-4762
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-4511
  • Fax: 503-714-6306
Mailing address:
  • Phone: 503-472-4511
  • Fax: 503-714-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberTHW2008
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberTHW2008
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: