Individual
SHYLA DESIRAE IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3455 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-3076
(503) 396-0228
Mailing address
2130 NE TRISHA DR, HILLSBORO, OR 97124-4007
(503) 396-0228
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201141116RN
OR
163WL0100X
Lactation Consultant (Registered Nurse)
201141116RN
OR
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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