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Individual

SHANNON MICHELLE SHEATS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
328 S CENTRAL AVE STE 101, MEDFORD, OR 97501-7274
(541) 500-8195
(541) 500-8196
Mailing address
328 S CENTRAL AVE STE 101, MEDFORD, OR 97501-7274
(541) 500-8195
(541) 500-8196

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201909972NP-PP
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500653487
OR
Enumeration date
04/26/2007
Last updated
02/10/2022
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