Dawn L Wylde, RN/QMHP-C

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

201401462RN Issued in OR

Practice address

17645 NW Saint Helens Rd
Portland, OR 97231-1729

Phone

(503) 621-1069

Fax

(503) 621-0200

NPI assigned

Dec 30, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Dawn L Cram Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1902261340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 SW MADISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051715",
            "telephone_number": "503-224-1044",
            "fax_number": "503-621-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17645 NW SAINT HELENS RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972311729",
            "telephone_number": "503-621-1069",
            "fax_number": "503-621-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12360 E Burnside St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972331042",
            "country_code": "US",
            "telephone_number": "971-279-4800",
            "fax_number": "971-279-2051",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "703 NE Hancock St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972123955",
            "country_code": "US",
            "telephone_number": "503-230-9875",
            "fax_number": "503-331-3441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "620 NE 2nd St",
            "address_purpose": "LOCATION",
            "city": "Gresham",
            "state": "OR",
            "postal_code": "970307514",
            "country_code": "US",
            "telephone_number": "971-274-3757",
            "fax_number": "503-912-5740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYLDE",
        "first_name": "DAWN",
        "middle_name": "L",
        "credential": "RN/QMHP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-30",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "23-QMHPC-001204",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60392843",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201401462RN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500798396",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2075923",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAWN",
            "last_name": "CRAM",
            "middle_name": "L",
            "credential": "RN/QMHP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Solange Marie Wyatt, MD
• Justin Wycoff, LMT
• Olivia Wycoff
• Mary Jayne Wykowski, LCSW
• Christie Wylde, ND
• Cynthia J Wyler, LMT
• Charles Wylie
• Linda S. Wylie, M.D.
• Regan B Wylie, MD
• James Wyma, RN

• Registered Nurse in Portland, OR
• Providers in Portland, OR by specialty
• Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.