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Individual

MS. SHALYN M VANDERBLOEMEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2222 NW LOVEJOY ST STE 606, PORTLAND, OR 97210-5104
(503) 413-5915
Mailing address
PO BOX 3808, PORTLAND, OR 97208-3808

Taxonomy

Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
4402
TN
363A00000X
Physician Assistant
4402
TN
363A00000X
Physician Assistant
Primary
PA223210
OR
363AS0400X
Surgical Physician Assistant
4402
TN

Other

Enumeration date
06/25/2009
Last updated
04/08/2025
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