Most Relevant Information
Provider Data
| NPI Number: | 1003592759 |
| Provider Name: | DEANNA RAE SHIELDS CHW/CRM/PSS |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: | THW000106791 |
Most Important Dates
| Enumeration Date: | 06/27/2023 |
| Last Updated: | 06/27/2023 |
Provider Practice Location
1631 SW COUMBIA ST
PORTLAND
OR
97201
Practice Location Phone/Fax
| Phone: | 5032312641 |
| Fax: | 5032311654 |
Provider Mailing Location
1776 SW MADISON ST
PORTLAND
OR
972051715
Provider Mailing Phone/Fax
| Phone: | 5032241044 |
| Fax: | 5036212235 |