Healthcare Provider Details

I. General information

NPI: 1639545585
Provider Name (Legal Business Name): SHAWNA ESPARZA NTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 SE OGDEN ST
PORTLAND OR
97202-7828
US

IV. Provider business mailing address

3837 SE OGDEN ST
PORTLAND OR
97202-7828
US

V. Phone/Fax

Practice location:
  • Phone: 503-849-9898
  • Fax:
Mailing address:
  • Phone: 503-849-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: