Provider Demographics
NPI:1568929370
Name:GREENE, SHANNA D (QMHA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:D
Last Name:GREENE
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11594
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-0594
Mailing Address - Country:US
Mailing Address - Phone:503-249-8855
Mailing Address - Fax:
Practice Address - Street 1:3530 N VANCOUVER AVE STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1798
Practice Address - Country:US
Practice Address - Phone:503-249-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator