Healthcare Provider Details

I. General information

NPI: 1851458590
Provider Name (Legal Business Name): WENDY E SHUMWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW WESTERN BLVD STE 330
CORVALLIS OR
97333-4082
US

IV. Provider business mailing address

1600 SW WESTERN BLVD STE 330
CORVALLIS OR
97333-4082
US

V. Phone/Fax

Practice location:
  • Phone: 541-738-8727
  • Fax: 541-758-4503
Mailing address:
  • Phone: 541-738-8727
  • Fax: 541-758-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD22322
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: