MEDICARE: SHELLEY ANN DENISON ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	077038996N3	OR

General Provider Information

NPI Number	:	1184872665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY ANN DENISON ANP

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10140 SW PARKWAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5008
Country	:	US
Telephone Number	:	503-215-2669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	07/22/2021

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Directions to “ SHELLEY ANN DENISON ANP” Practice Location

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