1164554499 NPI number — MRS. SHANA SCHONBERG DAVIS LMT

Table of content: MRS. SHANA SCHONBERG DAVIS LMT (NPI 1164554499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164554499 NPI number — MRS. SHANA SCHONBERG DAVIS LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
SHANA
Provider Middle Name:
SCHONBERG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHONBERG
Provider Other First Name:
SHANA
Provider Other Middle Name:
ALICIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164554499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4420 NE 77TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-493-2622
Provider Business Mailing Address Fax Number:
503-493-2622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3716 SE INTERNATIONAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-659-0073
Provider Business Practice Location Address Fax Number:
503-659-7471
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  7111 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)