MEDICARE: MS. SHARON BARBARA KNAPP NP

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	163WC0200X	Critical Care Medicine Registered Nurse	079043485RN	OR
2	363LF0000X	Family Nurse Practitioner	200150107NP-PP	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041178	OTHER	OR	CARE OREGON
2	297459	OTHER	OR	OMAP
3	ANP 0315	OTHER	OR	OREGON WORKER COMPENSATIO

General Provider Information

NPI Number	:	1962400374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON BARBARA KNAPP NP

Provider Business Mailing Address
First Line	:	3226 NE 56TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-3336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16126 SE HAPPY VALLEY TOWN CENTER DR
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97086-4256
Country	:	US
Telephone Number	:	503-658-1777
Fax Number	:	503-454-0505

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	10/26/2012

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