Individual
SHELBY LIDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19200 N KELSEY ST, MONROE, WA 98272-1431
(360) 794-7994
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 366-2983
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-2541
ID
363A00000X
Physician Assistant
Primary
PA60463924
WA
Other
Enumeration date
09/09/2014
Last updated
07/24/2025
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