Individual
MIRANDA SHEA BOEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
17979 NE GLISAN ST, PORTLAND, OR 97230-6507
(503) 962-1791
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201600700NP-PP
OR
363LF0000X
Family Nurse Practitioner
20366
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500707893
—
OR
Enumeration date
01/07/2011
Last updated
03/29/2021
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