Healthcare Provider Details

I. General information

NPI: 1750514535
Provider Name (Legal Business Name): SHANNON BRIANA SUHR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SW PINE STREET
CANYONVILLE OR
97417-0198
US

IV. Provider business mailing address

1077 GATEWAY LOOP
SPRINGFIELD OR
97477-1114
US

V. Phone/Fax

Practice location:
  • Phone: 541-839-4211
  • Fax: 541-839-4858
Mailing address:
  • Phone: 541-852-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200950075NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: