Individual
FOREST WAYNE SHIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1863 NE FREEMONT AVE, ROSEBURG, OR 97470-3535
(541) 733-2230
Mailing address
1863 NE FREEMONT AVE, ROSEBURG, OR 97470-3535
(541) 733-2230
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201392914NP-PP
OR
Other
Enumeration date
09/30/2013
Last updated
04/09/2014
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