Individual
NICOLE SHUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9224 N WILLAMETTE BLVD, PORTLAND, OR 97203-2957
(503) 706-9784
Mailing address
9224 N WILLAMETTE BLVD, PORTLAND, OR 97203-2957
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200842645RN
OR
Other
Enumeration date
09/09/2008
Last updated
09/09/2008
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