Provider Demographics
NPI:1710339635
Name:SHYBUT, ALEXANDER (CNA II)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:SHYBUT
Suffix:
Gender:M
Credentials:CNA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6935 N RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4933
Mailing Address - Country:US
Mailing Address - Phone:503-728-8581
Mailing Address - Fax:
Practice Address - Street 1:6935 N RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4933
Practice Address - Country:US
Practice Address - Phone:503-728-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201394560CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide