Individual
SHANNON TRUBATCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
905 SE 14TH AVE, PORTLAND, OR 97214-2569
(503) 622-8964
Mailing address
5821 NE 55TH AVE, PORTLAND, OR 97218-2433
(585) 698-7535
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/08/2026
Last updated
04/08/2026
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