Healthcare Provider Details

I. General information

NPI: 1437325669
Provider Name (Legal Business Name): PATRICIA F SHANGRAW FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA MARY FORD RN

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD MAIL CODE UHN-65 PAT CLINIC OREGON HEALTH AND SCIENCE U
PORTLAND OR
97239-3098
US

IV. Provider business mailing address

5776 SW CALUSA LOOP
TUALATIN OR
97062
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-1100
  • Fax: 503-494-1110
Mailing address:
  • Phone: 503-692-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200650158NPFNPPP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: