# SHIFT BEND FUNCTIONAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962041707
- **Authorized official:** DR. MARIE AGNEW FNP-C, DNP (OWNER AND MEDICAL PROVIDER)
- **Authorized official phone:** (541) 219-1910

## Contact information

- **Practice address:** 151 SW SHEVLIN HICKS DR, SUITE \#1, BEND, OR 97702
- **Practice address phone:** (541) 219-1910
- **Mailing address:** 556 NW TRENTON AVE, BEND, OR 97703-1126
- **Mailing address phone:** (541) 219-1910

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/26/2019
- **Last updated:** 12/26/2019