Basic Information
| Provider Information | |||||||||
| NPI: | 1205096765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDMANN | ||||||||
| FirstName: | SHONNA | ||||||||
| MiddleName: | RAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 S 11TH ST | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585045831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712351828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10220 SW GREENBURG RD | ||||||||
| Address2: | LINCOLN CENTER 3, SUITE 201 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972235503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887573422 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1065169 | OR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.