Provider Demographics
NPI:1831448687
Name:WACHTEL, SHILA (RN)
Entity type:Individual
Prefix:
First Name:SHILA
Middle Name:
Last Name:WACHTEL
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 1:7134 N IVANHOE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3943
Mailing Address - Country:US
Mailing Address - Phone:503-936-2153
Mailing Address - Fax:
Practice Address - Street 1:7134 N IVANHOE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3943
Practice Address - Country:US
Practice Address - Phone:503-936-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129236390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program