Provider Demographics
NPI:1497294847
Name:SHAY, VANESSA LYNN (RN, BSN, CBN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:SHAY
Suffix:
Gender:F
Credentials:RN, BSN, CBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 SW BOND AVE
Mailing Address - Street 2:MAIL CODE CH6D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-4373
Mailing Address - Fax:503-346-6960
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:MAIL CODE CH6D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-4373
Practice Address - Fax:503-346-6960
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201140764RN163WM0705X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical