Provider Demographics
NPI:1851458590
Name:SHUMWAY, WENDY E (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW WESTERN BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4082
Mailing Address - Country:US
Mailing Address - Phone:541-738-8727
Mailing Address - Fax:541-758-4503
Practice Address - Street 1:1600 SW WESTERN BLVD STE 330
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4082
Practice Address - Country:US
Practice Address - Phone:541-738-8727
Practice Address - Fax:541-758-4503
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF022922Medicare UPIN