Healthcare Provider Details

I. General information

NPI: 1699566117
Provider Name (Legal Business Name): RACHEL WYNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DR STE 300
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

17500 N 67TH AVE APT 1085
GLENDALE AZ
85308-1084
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4332
  • Fax:
Mailing address:
  • Phone: 562-242-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA226070
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: