Provider Demographics
NPI:1306722616
Name:YOURSHAW, GEORGINA
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:YOURSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEENIE
Other - Middle Name:
Other - Last Name:YOURSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10615 SE CHERRY BLOSSOM DR STE 250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3137
Mailing Address - Country:US
Mailing Address - Phone:971-373-4041
Mailing Address - Fax:971-373-5285
Practice Address - Street 1:10615 SE CHERRY BLOSSOM DR STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3137
Practice Address - Country:US
Practice Address - Phone:971-373-4041
Practice Address - Fax:971-373-5285
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program