Individual
MR. SHANE LAROY SHELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
880 COMMERCIAL ST SE, SALEM, OR 97302-4108
(541) 409-4066
Mailing address
880 COMMERCIAL ST SE, SALEM, OR 97302-4108
(541) 409-4066
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10028471
OR
Other
Enumeration date
10/02/2024
Last updated
10/02/2024
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