Healthcare Provider Details

I. General information

NPI: 1518948819
Provider Name (Legal Business Name): RHONDA LYNN WYLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2461 SW PERKINS AVE
PENDLETON OR
97801-4301
US

IV. Provider business mailing address

2461 SW PERKINS AVE
PENDLETON OR
97801-4301
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-0250
  • Fax: 541-276-0253
Mailing address:
  • Phone: 541-276-0250
  • Fax: 541-276-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15654
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: