Provider Demographics
NPI:1205661675
Name:TESKY, SHANNON ROSE (APRN NP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:TESKY
Suffix:
Gender:F
Credentials:APRN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-0348
Mailing Address - Country:US
Mailing Address - Phone:503-756-7885
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 348
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-0348
Practice Address - Country:US
Practice Address - Phone:503-756-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10030182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine