Individual
SHANE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2110 AUGUSTA ST, EUGENE, OR 97403-2202
(405) 630-5159
Mailing address
2110 AUGUSTA ST, EUGENE, OR 97403-2202
(405) 630-5159
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
116346
OK
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201810779RN
OR
Other
Enumeration date
11/19/2017
Last updated
07/05/2019
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