Provider Demographics
NPI:1497178479
Name:SHELDEN, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SHELDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19000
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12000 SW 49TH AVE
Practice Address - Street 2:#19000
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7132
Practice Address - Country:US
Practice Address - Phone:971-722-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078040147163WG0000X
OR078040147RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice