Provider Demographics
NPI:1417992579
Name:FRESHMAN HOUSE, SHARI S (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:S
Last Name:FRESHMAN HOUSE
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 1:721 NW 9TH AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3477
Mailing Address - Country:US
Mailing Address - Phone:503-525-0090
Mailing Address - Fax:
Practice Address - Street 1:721 NW 9TH AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3444
Practice Address - Country:US
Practice Address - Phone:503-525-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079043989N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027744OtherOREGON MEDICAL ASSISTANCE
OR027744OtherOREGON MEDICAL ASSISTANCE