Healthcare Provider Details

I. General information

NPI: 1083693295
Provider Name (Legal Business Name): SHARON DIXIE MCCONNELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARON DIXIE JONAS RN

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 SE MOUNT SCOTT BLVD
PORTLAND OR
97266-6302
US

IV. Provider business mailing address

9911 SE MOUNT SCOTT BLVD
PORTLAND OR
97266-6302
US

V. Phone/Fax

Practice location:
  • Phone: 801-703-3482
  • Fax:
Mailing address:
  • Phone: 801-703-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number353858-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN-301406
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: