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NPI Code Detail

MEDICARE: SHANNON E LUNDERS PA

MEDICARE: SHANNON E LUNDERS PA
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
1363A00000XPhysician AssistantPA211179OR
2363A00000XPhysician Assistant2907AZ

Other Identifiers

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

General Provider Information

NPI Number : 1689666844
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON E LUNDERS PA
Provider Business Mailing Address
First Line : 541 NE 20TH AVE STE 225
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2895
Country : US
Telephone Number : 503-963-2801
Fax Number : 503-963-2825
Provider Business Practice Location Address
First Line : 19250 SW 90TH AVE
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7585
Country : US
Telephone Number : 503-692-3750
Fax Number : 503-691-2324
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 05/09/2026

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1265428619 — RONALD JAY LEW MD
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1518954668 — MICHELLE MARIE BEILSTEIN MD
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1831167253 — OREGON CLINIC, PC
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1487611984 — JEFFREY MATTHEW DOUGLASS MD
Practice Location Address:
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Directions to “ SHANNON E LUNDERS PA” Practice Location

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