Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD00048484 | WA |
N | 111NI0900X | Internist | MD00048484 | WA |
Y | 207R00000X | Internist | MD160505 | OR |
Y | 111NI0900X | Internist | MD160505 | OR |
NPI | 1003002379 |
---|---|
Provider Name | Salona Shrestha |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 06/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8389686 | (05) | WA |
8497232 | (05) | WA |
P00468662 | RR MEDICARE (01) | WA |
P0048662 | RR MEDICARE (01) | WA |