Individual
SHAWNA KELLY-WICKERSHEIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPM
Contact information
Practice address
591 NE 2ND ST, PRINEVILLE, OR 97754-2014
(541) 550-6200
(541) 447-4118
Mailing address
591 NE 2ND ST, PRINEVILLE, OR 97754-2014
(541) 550-6200
(541) 447-4118
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
—
—
Other
Enumeration date
12/09/2013
Last updated
12/09/2013
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