Provider Demographics
NPI:1306442504
Name:NICHOLS, SHANNON P (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:P
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1545
Mailing Address - Country:US
Mailing Address - Phone:503-513-1300
Mailing Address - Fax:
Practice Address - Street 1:4400 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1545
Practice Address - Country:US
Practice Address - Phone:503-513-1300
Practice Address - Fax:503-513-1310
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041810RN163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice