Provider Demographics
NPI:1962540310
Name:SHATTUCK, LAURA ANN (PNP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:SHATTUCK
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21440 S UPPER HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97004-8814
Mailing Address - Country:US
Mailing Address - Phone:503-632-3172
Mailing Address - Fax:
Practice Address - Street 1:21440 S UPPER HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OR
Practice Address - Zip Code:97004-8814
Practice Address - Country:US
Practice Address - Phone:503-632-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care