Provider Demographics
NPI:1821214156
Name:SHIBLEY, DANA RAE (LDEM)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:RAE
Last Name:SHIBLEY
Suffix:
Gender:F
Credentials:LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37010 SE SNUFFIN RD
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-8760
Mailing Address - Country:US
Mailing Address - Phone:503-789-3145
Mailing Address - Fax:
Practice Address - Street 1:37010 SE SNUFFIN RD
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-8760
Practice Address - Country:US
Practice Address - Phone:503-789-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-1004924176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife