Individual
SHEA KEPHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
93016 MARCOLA RD, MARCOLA, OR 97454-9714
(541) 513-8949
Mailing address
93016 MARCOLA RD, MARCOLA, OR 97454-9714
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0200040662
OR
163WM0705X
Medical-Surgical Registered Nurse
Primary
0200040662
OR
Other
Enumeration date
04/14/2014
Last updated
04/14/2014
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