Provider Demographics
NPI:1336339647
Name:ARNESON, SHIRLEY (ANP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ARNESON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 THIRD ST
Mailing Address - Street 2:BAY OCEAN MEDICAL, PC
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141
Mailing Address - Country:US
Mailing Address - Phone:503-842-7533
Mailing Address - Fax:503-842-9636
Practice Address - Street 1:1011 THIRD ST
Practice Address - Street 2:BAY OCEAN MEDICAL, PC
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141
Practice Address - Country:US
Practice Address - Phone:503-842-7533
Practice Address - Fax:503-842-9636
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045295N3 ANP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR141994Medicare PIN