NPI 1245806934

The Wig Gallery LLC

Organisation Preferred Provider Organization Portland, OR

Practice location

Address: 8401 NE Halsey St STE 101, Portland, OR 97220-5670
Phone: (503) 253-5680
Mailing address: 13918 NE Milton St, Portland, OR 97230-2975

Authorised official

Name: Debra Ann Petrie
Title: Owner
Phone: (503) 255-3432

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1245806934
Entity type: Organization
NPI issued: 2 Jun 2021
Record last updated: 2 Jun 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.