Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | OR 093006979N7 | OR |
NPI | 1003908120 |
---|---|
Provider Name | Ms. Kimberly Susan Shotz |
First Address | Portland, OR 97215-1990 |
Second Address | Portland, OR 97215-1990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 01/06/2015 |