Provider Demographics
NPI:1821157538
Name:BLAKE, SHAREN ANN (CNM)
Entity Type:Individual
Prefix:MS
First Name:SHAREN
Middle Name:ANN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16454 SE ORMAE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-5168
Mailing Address - Country:US
Mailing Address - Phone:503-513-0821
Mailing Address - Fax:
Practice Address - Street 1:KAISER SUNNYSIDE HOSPITAL
Practice Address - Street 2:10180 SE SUNNYSIDE RD
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-571-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083038473N5 NMNP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife