Provider Demographics
NPI:1679513493
Name:WETTLAUFER, SHEILA L (CSFNP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:L
Last Name:WETTLAUFER
Suffix:
Gender:F
Credentials:CSFNP
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:L
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFNP
Mailing Address - Street 1:4285 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4371
Mailing Address - Country:US
Mailing Address - Phone:503-585-6455
Mailing Address - Fax:503-391-0471
Practice Address - Street 1:4285 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4371
Practice Address - Country:US
Practice Address - Phone:503-585-6455
Practice Address - Fax:503-391-0471
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNP135211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine