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NPI Code Detail

MEDICARE: MS. SHAUNA L ENSMINGER MD

MEDICARE: MS. SHAUNA L ENSMINGER MD
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
1207Q00000XFamily Medicine PhysicianMD00041452WA
2207Q00000XFamily Medicine PhysicianMD19637OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619960002
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHAUNA L ENSMINGER MD
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number : 503-215-6494
Fax Number : 503-215-6644
Provider Business Practice Location Address
First Line : 4920 N. INTERSTATE AVENUE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-3653
Country : US
Telephone Number : 503-215-3300
Fax Number : 503-215-3350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 03/09/2021

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