Healthcare Provider Details

I. General information

NPI: 1346582046
Provider Name (Legal Business Name): SHANNON MACRITCHIE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 RIVERBEND DR.
SPRINGFIELD OR
97401
US

IV. Provider business mailing address

3333 RIVERBEND DR.
SPRINGFIELD OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-8757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO175898
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: