Healthcare Provider Details

I. General information

NPI: 1801302849
Provider Name (Legal Business Name): SHAWNA L. ALL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. SHAWNA L. STEWART

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SE EMIGRANT AVE.
PENDLETON OR
97801
US

IV. Provider business mailing address

PO BOX 1711
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 971-331-4777
  • Fax:
Mailing address:
  • Phone: 971-331-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number18055
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18055
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: