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Individual

IGOR V SHAPOVAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ARNP

Contact information

Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 813-2000
Mailing address
11105 NE 102ND ST, VANCOUVER, WA 98662-3302

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP61578314
WA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
09/29/2023
Last updated
12/06/2024
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