Shannon Thurston, CNM
Advanced Practice Midwife in Gresham, OR. Individual provider (NPI-1).
NPI number1134813405
StatusActive
Last updated in NPPESAug 14, 2023
Details
- NPI
- 1134813405
- Entity type
- Individual (NPI-1)
- Name
- Shannon Thurston
- Credential
- CNM
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 7, 2023
- Certification date
- Aug 14, 2023
- Last updated
- Aug 14, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CERTIFIED NURSE MIDWIFE (CNM)
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367A00000X | Advanced Practice Midwife | 10009305 | OR | Yes |
| 176B00000X | Midwife | 10009305 | OR |
Other names
- Shannon Duletzke (Former Name)
Practice location
24850 Se Stark St Ste 200Gresham, OR 97030-8320
Phone 503-491-9444
Mailing address
24850 Se Stark St Ste 200Gresham, OR 97030-8320
Phone 503-491-9444
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 10 Advanced Practice Midwife providers in Gresham · All 2,430 providers in Gresham
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