Individual
MR. SHANNON LEE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP, MPH
Contact information
Practice address
619 NW 6TH AVE FL 3, PORTLAND, OR 97209-3964
(503) 988-5020
(503) 988-5022
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201250082NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22959
—
OR
Enumeration date
07/09/2012
Last updated
11/26/2019
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