Provider Demographics
NPI:1144246299
Name:WEID, SHELLEY LYNN (CNM)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:LYNN
Last Name:WEID
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 PROVIDENCE DR.
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132
Mailing Address - Country:US
Mailing Address - Phone:503-538-2698
Mailing Address - Fax:503-554-9328
Practice Address - Street 1:1003 PROVIDENCE DR.
Practice Address - Street 2:SUITE 340
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132
Practice Address - Country:US
Practice Address - Phone:503-538-2698
Practice Address - Fax:503-554-9328
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029010Medicaid
ORS48757Medicare UPIN
OR118037Medicare ID - Type Unspecified