Provider Demographics
NPI:1952314841
Name:CARRAWAY, SHARLEEN PAYNICH (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SHARLEEN
Middle Name:PAYNICH
Last Name:CARRAWAY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 NE 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3647
Mailing Address - Country:US
Mailing Address - Phone:503-288-0083
Mailing Address - Fax:503-288-7843
Practice Address - Street 1:2647 NE 33RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3647
Practice Address - Country:US
Practice Address - Phone:503-288-0083
Practice Address - Fax:503-288-7843
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR96007190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily