Healthcare Provider Details

I. General information

NPI: 1124591466
Provider Name (Legal Business Name): MEGAN MAXINE SHIERE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 SE 182ND AVE
GRESHAM OR
97030-5036
US

IV. Provider business mailing address

2700 W POWELL BLVD APT M197
GRESHAM OR
97030-6512
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-0183
  • Fax:
Mailing address:
  • Phone: 503-991-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number201706342LPN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: