Individual
SHILO MARIE MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNMNP
Contact information
Practice address
29135 ELLENSBURG AVE, GOLD BEACH, OR 97444-8722
(541) 425-5311
(541) 425-5577
Mailing address
PO BOX 1710, GOLD BEACH, OR 97444-1710
(541) 425-5311
(541) 425-5577
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
200950160NP NMNP-PP
OR
363L00000X
Nurse Practitioner
200950160NP NMNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386069326
BRIGHT EYES MIDWIFERY & WILD RIVERS WOMEN'S HEALTH LLC NPI
OR
01
—
1487696985
CURRY GENERAL HOSPITAL NPI
—
05
—
500614877
—
OR
01
—
R179539
BRIGHT EYES MIDWIFERY & WILD RIVERS WOMEN'S HEALTH, LLC PTAN
OR
Enumeration date
11/20/2009
Last updated
04/03/2015
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