Provider Demographics
NPI:1083019723
Name:SHENA VANDER PLOEG ND PC
Entity Type:Organization
Organization Name:SHENA VANDER PLOEG ND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VANDER PLOEG
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-236-7610
Mailing Address - Street 1:21885 WILLAMETTE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3260
Mailing Address - Country:US
Mailing Address - Phone:971-236-7610
Mailing Address - Fax:888-398-0996
Practice Address - Street 1:905 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1349
Practice Address - Country:US
Practice Address - Phone:971-236-7610
Practice Address - Fax:888-398-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization