Individual
DIANE SHINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 W MAIN ST, MEDFORD, OR 97501-2756
(541) 326-7228
Mailing address
300 W MAIN ST, MEDFORD, OR 97501-2756
(541) 326-7228
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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