Healthcare Provider Details

I. General information

NPI: 1225378938
Provider Name (Legal Business Name): SHARLA GALE MCKENNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARLA GALE CECIL

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 NE COURTNEY DR
BEND OR
97701-7638
US

IV. Provider business mailing address

2577 NE COURTNEY DR
BEND OR
97701-7638
US

V. Phone/Fax

Practice location:
  • Phone: 541-322-7500
  • Fax: 541-322-7565
Mailing address:
  • Phone: 541-322-7500
  • Fax: 541-322-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: