Individual
SHANNON MARIE STOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4805 NE GLISAN ST # 6N60, PORTLAND, OR 97213-2933
(503) 281-0561
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA206024
OR
363AS0400X
Surgical Physician Assistant
Primary
PA206024
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2182305
—
WA
05
—
500796288
—
OR
Enumeration date
06/02/2021
Last updated
04/21/2026
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