Healthcare Provider Details

I. General information

NPI: 1730604166
Provider Name (Legal Business Name): SHIRLEY LYNN HANLEY DR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25117 SW PARKWAY AVE STE B
WILSONVILLE OR
97070
US

IV. Provider business mailing address

25117 SW PARKWAY AVE STE B
WILSONVILLE OR
97070-9697
US

V. Phone/Fax

Practice location:
  • Phone: 971-224-2505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF06172350
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06172350
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: