Individual
SHAYLENE TAMARA WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
(503) 666-4047
Mailing address
12207 NE 116TH ST, VANCOUVER, WA 98682-2040
(480) 268-3933
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201905089RN
OR
Other
Enumeration date
11/14/2019
Last updated
11/14/2019
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