Individual
SHELBY LEIGH BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
83 SW K ST, MADRAS, OR 97741-1046
(503) 506-0474
Mailing address
83 SW K ST, MADRAS, OR 97741-1046
(503) 506-0474
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA222574
OR
363AM0700X
Medical Physician Assistant
PA64972
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/13/2023
Last updated
12/23/2024
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