Provider Demographics
NPI:1740451475
Name:NUGENT-SHAH, DANNA K
Entity type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:K
Last Name:NUGENT-SHAH
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 1:120 KINGSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1367
Mailing Address - Country:US
Mailing Address - Phone:503-713-7742
Mailing Address - Fax:
Practice Address - Street 1:2191 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9108
Practice Address - Country:US
Practice Address - Phone:503-980-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1039473172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker