Provider Demographics
NPI:1750120747
Name:TAYLOR, SHAWNA ROSE (RN)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:ROSE
Last Name:TAYLOR
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 1:2032 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-9568
Mailing Address - Country:US
Mailing Address - Phone:541-399-4736
Mailing Address - Fax:
Practice Address - Street 1:838 GARDEN CT
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-4404
Practice Address - Country:US
Practice Address - Phone:541-399-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201392048RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty