Provider Demographics
NPI:1356436711
Name:ALEXANDER, SHANA LEE (RN)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:LEE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73424 BURKE ROAD
Mailing Address - Street 2:BOX B4
Mailing Address - City:CAYUSE
Mailing Address - State:OR
Mailing Address - Zip Code:97821
Mailing Address - Country:US
Mailing Address - Phone:541-276-3626
Mailing Address - Fax:
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096000550 RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171037Medicaid