Individual
SHANA R GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC/ ANP-BC
Contact information
Practice address
3930 SE DIVISION ST, PORTLAND, OR 97202-1643
(503) 418-3900
Mailing address
1400 SW 5TH AVE, PORTLAND, OR 97201-5537
(503) 418-3900
(503) 418-3938
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
708000
CA
163W00000X
Registered Nurse
RN.1650946
CO
363LA2200X
Adult Health Nurse Practitioner
Primary
201150173NP
OR
363LA2200X
Adult Health Nurse Practitioner
21009
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
21009
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APN.0993439-NP
CO
Other
Enumeration date
12/14/2011
Last updated
03/11/2025
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