Healthcare Provider Details

I. General information

NPI: 1023200201
Provider Name (Legal Business Name): SHIELA MAY VANDERVEER LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 GRAVENSTEIN HWY S
SEBASTOPOL CA
95472-4837
US

IV. Provider business mailing address

1604 GRAVENSTEIN HWY S
SEBASTOPOL CA
95472-4837
US

V. Phone/Fax

Practice location:
  • Phone: 510-374-9193
  • Fax: 707-306-7579
Mailing address:
  • Phone: 510-374-9193
  • Fax: 707-306-7579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number07034R
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: