Individual
SHANNON B DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5441 S MACADAM AVE STE R, PORTLAND, OR 97239-3822
(503) 974-4951
Mailing address
1030 NW 12TH AVE APT 130, PORTLAND, OR 97209-2840
(503) 320-0024
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201908910RN
OR
Other
Enumeration date
09/23/2025
Last updated
09/23/2025
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