Provider Demographics
NPI:1639545585
Name:ESPARZA, SHAWNA (NTC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:NTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 SE OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7828
Mailing Address - Country:US
Mailing Address - Phone:503-849-9898
Mailing Address - Fax:
Practice Address - Street 1:3837 SE OGDEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7828
Practice Address - Country:US
Practice Address - Phone:503-849-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education