Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 202200281NP-PP | OR |
NPI | 1043971625 |
---|---|
Provider Name | Sydney Lea Shannon |
First Address | Portland, OR 97223-8692 |
Second Address | Hillsboro, OR 97124-5831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2022 |
Last Update Date | 26/01/2022 |