Individual
MRS. SHARON KRISTINE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
5871 SW BADGER RD, TERREBONNE, OR 97760-8936
(503) 313-2618
Mailing address
5871 SW BADGER RD, TERREBONNE, OR 97760-8936
(503) 313-2618
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
096007212RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096007212RN
RN LICENSE
OR
Enumeration date
09/12/2018
Last updated
09/12/2018
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