Basic Information
| Provider Information | |||||||||
| NPI: | 1346536992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANNON | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 364 SE 8TH AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971234253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036814145 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 364 SE 8TH AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971234253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036814145 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 201150052NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 500635927 | 05 | OR | MEDICAID | 1346536992 | 05 | WA | MEDICAID |