| Doctor Name: | MRS. SHANA S STARK |
| NPI Number: | 1124443676 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 201501818NP-PP |
| Business Practice Address: | 500 5th St Brookings, OR - 974159702 |
| Business Phone Number: | 5414122000 |
| Business Fax Number: | 5414122081 |
| Mailing Address: | 94220 4th St, GOLD BEACH |
| State: | OR |
| Postal Code: | 974447756 |
| Phone Number: | 5412473000 |
| Fax Number: | 5412473101 |
| NPI Enumeration Date: | 02/20/2014 |
| NPI Last Update Date: | 08/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 201501818NP-PP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |