Individual
SHANNON P NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4400 NE HALSEY ST, PORTLAND, OR 97213-1545
(503) 513-1300
(503) 513-1310
Mailing address
4400 NE HALSEY ST, PORTLAND, OR 97213-1545
(503) 513-1300
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
201041810RN
OR
Other
Enumeration date
12/11/2020
Last updated
07/18/2024
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