Provider Demographics
NPI:1659817351
Name:MORAN, SHEILA KATHLEEN (LAC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:KATHLEEN
Last Name:MORAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34065 WOOD DUCK AVE
Mailing Address - Street 2:
Mailing Address - City:NEHALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97131-9760
Mailing Address - Country:US
Mailing Address - Phone:503-812-2022
Mailing Address - Fax:
Practice Address - Street 1:34065 WOOD DUCK AVE
Practice Address - Street 2:
Practice Address - City:NEHALEM
Practice Address - State:OR
Practice Address - Zip Code:97131-9760
Practice Address - Country:US
Practice Address - Phone:503-812-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00081171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist