Provider Demographics
NPI:1134800113
Name:MARSHALL, SHAWN MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18015 S WINDY CITY RD
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-8785
Mailing Address - Country:US
Mailing Address - Phone:503-489-8446
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 316
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2470
Practice Address - Country:US
Practice Address - Phone:503-974-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10013338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily