Basic Information
| Provider Information | |||||||||
| NPI: | 1023775178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULRENNAN | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8222 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 830028222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177898257 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9000 N LOMBARD ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972033006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039885558 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2021 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 202109996NP-PP | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.