Individual
MR. SHANNON RAY DITTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
4232 NE 62ND AVE, PORTLAND, OR 97218-3204
(971) 275-3186
Mailing address
4232 NE 62ND AVE, PORTLAND, OR 97218-3204
(971) 275-3186
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200642863RN
OR
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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