Provider Demographics
NPI:1205096765
Name:GOLDMANN, SHONNA RAE
Entity type:Individual
Prefix:
First Name:SHONNA
Middle Name:RAE
Last Name:GOLDMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5831
Mailing Address - Country:US
Mailing Address - Phone:971-235-1828
Mailing Address - Fax:
Practice Address - Street 1:10220 SW GREENBURG RD
Practice Address - Street 2:LINCOLN CENTER 3, SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5503
Practice Address - Country:US
Practice Address - Phone:888-757-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1065169314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility