Provider Demographics
NPI:1083693295
Name:MCCONNELL, SHARON DIXIE (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DIXIE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DIXIE
Other - Last Name:JONAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9911 SE MOUNT SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6302
Mailing Address - Country:US
Mailing Address - Phone:801-703-3482
Mailing Address - Fax:
Practice Address - Street 1:9911 SE MOUNT SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6302
Practice Address - Country:US
Practice Address - Phone:801-703-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353858-3102163WG0000X
OHRN-301406163WG0000X
OR163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN-301406OtherRN LICENSE
UT353858-3102OtherRN LICENSE