Provider Demographics
NPI:1407312143
Name:FINCK, SHELLIE ANNE YOSHIE (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLIE ANNE
Middle Name:YOSHIE
Last Name:FINCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22118 SW HAIL PL
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8056
Mailing Address - Country:US
Mailing Address - Phone:503-515-5660
Mailing Address - Fax:
Practice Address - Street 1:831 NW COUNCIL DR STE 101
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3722
Practice Address - Country:US
Practice Address - Phone:503-665-8176
Practice Address - Fax:503-665-8178
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201900885NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily