Provider Demographics
NPI:1609137181
Name:CARRICK, SHELAGH (LM)
Entity Type:Individual
Prefix:
First Name:SHELAGH
Middle Name:
Last Name:CARRICK
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 ROY AVE
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-9101
Mailing Address - Country:US
Mailing Address - Phone:707-464-9664
Mailing Address - Fax:
Practice Address - Street 1:2610 ROY AVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-9101
Practice Address - Country:US
Practice Address - Phone:707-464-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACALM111176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACALM111OtherCALIFORNIA MEDICAL BOARD