Individual
JENNIFER SHANNON HAAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
727 S WAHANNA RD, SEASIDE, OR 97138-7735
(503) 717-7060
Mailing address
PO BOX 3397, PORTLAND, OR 97208-3397
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024172937
VA
363LA2200X
Adult Health Nurse Practitioner
0024172937
VA
363LG0600X
Gerontology Nurse Practitioner
Primary
201707705NP-PP
OR
Other
Enumeration date
03/16/2016
Last updated
01/14/2021
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