Provider Demographics
NPI:1932461688
Name:WOMEN'S HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, NP
Authorized Official - Phone:541-984-3000
Mailing Address - Street 1:1755 COBURG RD
Mailing Address - Street 2:BLDG 1, SUITE 2
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4982
Mailing Address - Country:US
Mailing Address - Phone:541-984-3000
Mailing Address - Fax:541-485-7266
Practice Address - Street 1:1755 COBURG RD
Practice Address - Street 2:BLDG 1, SUITE 2
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4982
Practice Address - Country:US
Practice Address - Phone:541-984-3000
Practice Address - Fax:541-485-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045016N5261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1760571079OtherINDIVIDUAL NPI