Provider Demographics
NPI:1912235516
Name:MCKENZIE, SHILO MARIE (CNMNP)
Entity Type:Individual
Prefix:
First Name:SHILO
Middle Name:MARIE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CNMNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-1710
Mailing Address - Country:US
Mailing Address - Phone:541-425-5311
Mailing Address - Fax:541-425-5577
Practice Address - Street 1:29135 ELLENSBURG AVE
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-8722
Practice Address - Country:US
Practice Address - Phone:541-425-5311
Practice Address - Fax:541-425-5577
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950160NP NMNP-PP176B00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1386069326OtherBRIGHT EYES MIDWIFERY & WILD RIVERS WOMEN'S HEALTH LLC NPI
OR500614877Medicaid
ORR179539OtherBRIGHT EYES MIDWIFERY & WILD RIVERS WOMEN'S HEALTH, LLC PTAN
1487696985OtherCURRY GENERAL HOSPITAL NPI
OR1386069326OtherBRIGHT EYES MIDWIFERY & WILD RIVERS WOMEN'S HEALTH LLC NPI
OR500614877Medicaid
1083656367OtherCURRY MEDICAL CENTER NPI
1235145624OtherCURRY WOMENS CLINIC NPI
1487696985OtherCURRY MEDICAL CENTER PART A
38-3990OtherCURRY FAMILY MEDICAL MEDICARE PART A
R0000ZGBDGOtherCURRY MEDICAL CENTER MEDICARE PART B
119263OtherCURRY MEDICAL CENTER MEDICAID
1487696985OtherCURRY GENERAL HOSPITAL NPI