Provider Demographics
NPI:1174796528
Name:WIMBER, CARMEL (PA-C, MS)
Entity type:Individual
Prefix:MS
First Name:CARMEL
Middle Name:
Last Name:WIMBER
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S BOND AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-4314
Mailing Address - Fax:
Practice Address - Street 1:501 N GRAHAM ST STE 330B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2009
Practice Address - Country:US
Practice Address - Phone:503-413-3690
Practice Address - Fax:503-413-3360
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA150424363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant