Provider Demographics
NPI:1023200201
Name:VANDERVEER, SHIELA MAY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:MAY
Last Name:VANDERVEER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 GRAVENSTEIN HWY S
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4837
Mailing Address - Country:US
Mailing Address - Phone:510-374-9193
Mailing Address - Fax:707-306-7579
Practice Address - Street 1:1604 GRAVENSTEIN HWY S
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4837
Practice Address - Country:US
Practice Address - Phone:510-374-9193
Practice Address - Fax:707-306-7579
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM07034R175M00000X
CA224367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No175M00000XOther Service ProvidersMidwife, Lay