Most Relevant Information
Provider Data
| NPI Number: | 1003493479 |
| Provider Name: | SHANA AXTHELM |
| Entity Type: | Individual |
| Taxonomy Code: | 372600000X |
| Specialty: | Adult Companion |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/24/2021 |
| Last Updated: | 03/24/2021 |
Provider Practice Location
847 NE 19TH AVE
PORTLAND
OR
972322684
Practice Location Phone/Fax
| Phone: | 5037609606 |
| Fax: |
Provider Mailing Location
847 NE 19TH AVE
PORTLAND
OR
972322684
Provider Mailing Phone/Fax
| Phone: | 5037609606 |
| Fax: |