Individual
MRS. SHANELLE DEANN O'DELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
440 NW DIVISION ST, GRESHAM, OR 97030-5506
(503) 215-9500
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01195
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500641047
—
OR
Enumeration date
04/25/2007
Last updated
06/21/2021
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