Healthcare Provider Details

I. General information

NPI: 1053379479
Provider Name (Legal Business Name): SHEILA M SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILA M GOURD FNP

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 N SPRINGBROOK RD STE B
NEWBERG OR
97132-2061
US

IV. Provider business mailing address

1014 N SPRINGBROOK RD STE B
NEWBERG OR
97132-2061
US

V. Phone/Fax

Practice location:
  • Phone: 503-449-8988
  • Fax: 503-894-9194
Mailing address:
  • Phone: 503-449-8988
  • Fax: 503-894-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201350039NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: