Provider Demographics
NPI:1841763075
Name:MILLER, SHELLY WEBER (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:WEBER
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 E ST STE H
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-1714
Mailing Address - Country:US
Mailing Address - Phone:360-818-7500
Mailing Address - Fax:
Practice Address - Street 1:2632 E ST STE H
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1714
Practice Address - Country:US
Practice Address - Phone:360-818-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-152515163WL0100X
WARN60452040163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant