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General NPI Number Information
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NPI Number | 1083019723
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Entity Type | Organization
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Legal Business Name | SHENA VANDER PLOEG ND PC
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 905 SE ANKENY ST
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City | PORTLAND
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State | OR
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Zip | 97214-1349
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Country | US
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Telephone | 971-236-7610
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Fax | 888-398-0996
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Provider Business Mailing Address
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Address Line | 21885 WILLAMETTE DR
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City | WEST LINN
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State | OR
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Zip | 97068-3260
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Country | US
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Telephone | 971-236-7610
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Fax | 888-398-0996
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Authorized Official
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Title or Position | OWNER
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Name | MISS SHENA MARIE VANDER PLOEG
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Credential | ND
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Telephone | 971-236-7610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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