Provider Demographics
NPI:1851707814
Name:SHASTEEN, MORGAN KRISTA (NP-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:KRISTA
Last Name:SHASTEEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:SHASTEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:1255 HILYARD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1255 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3718
Practice Address - Country:US
Practice Address - Phone:541-686-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201603832NP-PP363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115775Medicaid
OH0115775Medicaid
OHH462001Medicare PIN