1679513493 NPI number — SHEILA L. WETTLAUFER CSFNP

Table of content: SHEILA L. WETTLAUFER CSFNP (NPI 1679513493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679513493 NPI number — SHEILA L. WETTLAUFER CSFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WETTLAUFER
Provider First Name:
SHEILA
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDNER
Provider Other First Name:
SHEILA
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSFNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679513493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4285 COMMERCIAL ST SE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97302-4371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-585-6455
Provider Business Mailing Address Fax Number:
503-391-0471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4285 COMMERCIAL ST SE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-585-6455
Provider Business Practice Location Address Fax Number:
503-391-0471
Provider Enumeration Date:
06/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  NP135211 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)