SHANNON MARIE STOLL PAC NPI 1144896879

NPI Information

NPI: 1144896879
Provider Name: SHANNON MARIE STOLL, PAC
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
4805 NE GLISAN ST # 6N60
PORTLAND, OR
ZIP 97213
Phone: (503) 281-0561
Get Directions

Shannon Marie Stoll, PAC is a surgical physician assistant in Portland, OR with 3 years of experience. Shannon Marie Stoll, PAC NPI is 1144896879. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4805 NE GLISAN ST # 6N60
PORTLAND, OR
ZIP 97213-933
Phone: (503) 281-0561

The NPI 1144896879 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/2/2021 and was last updated on 1/10/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	PA206024	OREGON	Yes
2	363A00000X	Physician Assistant		PA206024	OREGON	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500796288	MEDICAID	OREGON
2	2182305	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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