Provider Demographics
NPI:1558734020
Name:DOCKTER, SHONTEE
Entity Type:Individual
Prefix:
First Name:SHONTEE
Middle Name:
Last Name:DOCKTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 82153
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282
Mailing Address - Country:US
Mailing Address - Phone:971-212-3261
Mailing Address - Fax:
Practice Address - Street 1:4446 SE RURAL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-7773
Practice Address - Country:US
Practice Address - Phone:971-212-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2019-06-19
Deactivation Date:2018-06-08
Deactivation Code:
Reactivation Date:2019-06-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula